Autologous fascia pubovaginal slings after prior synthetic anti-incontinence procedures for recurrent incontinence: A multi-institutional prospective comparative analysis to de novo autologous slings assessing objective and subjective cure

ABSTRACT Aims Given the paucity of prospective data on the treatment of incontinent women with prior synthetic mid‐urethral sling (MUS), we sought to report our prospective experience with autologous fascia pubovaginal sling placement (AF‐PVS) after prior synthetic mid‐urethral sling (MUS). Methods An IRB‐approved, multi‐institutional, prospective cohort of patients from 2010 to 2013 undergoing AF‐PVS for urinary incontinence was evaluated and stratified for the presence of a prior MUS. Pre‐operative characteristics and validated quality of life questionnaires (IIQ‐7 and UDI‐6) were compared to post‐operative pad usage, scores on the IIQ‐7 and UDI‐6, complications, and visual analog scale assessment of improvement. Results 288 patients met inclusion criteria, 59 (20.4%) of whom had undergone a prior MUS before AF‐PVS placement. Of these 59 patients, 20 (33.9%) had a prior vaginal extrusion and 5 (8.5%) had suffered from obstruction requiring sling lysis or excision. With a median of 14 months follow‐up, prior MUS placement was not associated with a significant difference in objective (55.9% vs. 62.4%, P = 0.37) or subjective cure (66.1% vs. 69.0%, P = 0.75) when compared to patients undergoing placement of an initial AF‐PVS. Patients undergoing AF‐PVS after prior MUS did have a significantly higher rate of urinary retention requiring intermittent catheterization (8.5% vs. 3.1%, P