Comparing mid-term outcomes of pubovaginal slings using rectus autologous fascia with polyvinylidene fluoride tape slings in the management of female stress urinary incontinence: A prospective cohort study with at least 3 years of follow-up

Abstract

OBJECTIVE: To compare the outcomes of classic pubovaginal slings (PVS) using autologous rectus fascia (ARF) with tension-free vaginal suprapubic arch slings using polyvinylidene fluoride (PVDF) tape for the treatment of females with stress urinary incontinence (SUI). METHODS: Women with severe SUI were included in this prospective study. Follow-up was scheduled at 1, 6, 12, 24 and 36 months postoperatively. Data on the subjective success rate were collected by comparing the scores of the International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms Long Form (ICIQ-FLUTS) at baseline and postoperative follow-up sessions. Objective success was investigated using pad tests and cough tests. Overall success rate, frequency of complications, incidence of each complication, and severity of complications (based on the Clavien-Dindo classification) were compared between the two groups after at least 3 years of follow-up. RESULTS: Between January 2012 and December 2023, 166 women with severe SUI underwent a slingplasty. The final analysis was based on 125 women: 73 in the PVDF sling group and 52 in the ARF PVS group. The mean follow-up time was 41 months in the PVDF sling group and 38 months in the ARF PVS group. The length of surgery was significantly shorter in the PVDF sling group (32.44 +/- 4.04 vs 91.08 +/- 7.74 min; p = 0.000). SUI disappeared or improved in >90 of patients in both groups, and these cure rates were similar to those obtained 1 year after surgery. The success rate was 93 in the PVDF sling group and 94 in the ARF PVS group. The overall complication rate was 47.2 in the ARF PVS group and 25 in the PVDF sling group (p = 0.049). Grade 2 complications occurred more frequently in the ARF PVS group (p = 0.042). The ICIQ-FLUTS LF score improved for both groups, with no significant difference between complications. CONCLUSION: The 3-year data from this study indicate that the efficacy of slings made with PVDF tape is comparable with the efficacy of ARF PVS. PVDF tape was associated with low rates of foreign body reaction in this population of patients, and both methods had the same success rate. PVDF tape is biocompatible for mid-urethral slings, but further studies with long-term follow-up should be performed to confirm these preliminary data.