FAILURE RATES FOR PORCINE DERMAL AND CADAVERIC FASCIAL SLINGS AS COMPARED TO AUTOLOGOUS TISSUE FOR TREATMENT OF URODYNAMIC STRESS INCONTINENCE

A.J. Simsiman,* C.R. Powell,** R. Stratford,* S.A. Menefee*

*  Kaiser Permanente Southern California, San Diego, CA

** Naval Medical Center, San Diego, CA

 OBJECTIVE:  We sought to determine whether the outcome of suburethral slings for urodynamic stress incontinence (USI) was influenced by type of sling material.

MATERIALS AND METHODS:  Medical records were retrospectively reviewed for all women who underwent a suburethral sling from January 1997 to January 2003.   Sling material consisted of autograft (rectus fascia or fascia lata), allograft (cadaveric fascia lata) and xenograft (porcine dermis).  Decision as to which tissue to use was based upon surgeon’s discussion with the patient. Surgeries were performed in a similar manner by one of 3 surgeons. Preoperatively all patients had confirmed USI. Objective failure was defined as leakage of urine upon cough stress test; objective cure was defined as no leakage upon standing cough stress test with a minimum of 200cc bladder volume.  Subjective failure was defined as a positive response to the question “Do you ever leak with activity, cough or sneeze?” on a standardized written pelvic floor questionnaire. Success required a minimum of 12 months postoperative follow-up; failures are reported at time of failure.

RESULTS: Two hundred and forty-one women are included in this analysis: 78 received autograft, 80 received allograft and 83 received xenograft. One hundred percent of patients from each group were available for subjective postoperative outcome assessment. Patients had a mean age of 56 years, median parity of 3 and mean body mass index (BMI) of 30 kg/m2.  The autograft and xenograft groups were similar for these characteristics; the allograft group tended to be slightly older (p<0.05).  Twelve percent of the xenograft group had undergone prior reconstructive surgery as compared to 24% in the other groups (p<0.05); concomitant surgeries were similar amongst all groups (p<0.05).

	Objective failure	Sig	Subjective failure	Sig	Mean follow-up in months (range)
Autograft N=78	12% (9/74)	p=0.001 vs allograft p<0.001 vs xenograft	29% (23/78)	p=0.003 vs allograft p=0.004 vs xenograft	Cure group: 22    (12-72) Failure group: 26    (13-44)
Allograft N=80	34% (25/73)		52% (42/80)		Cure group: 29    (12-60) Failure group: 22    (5-55)…
Xenograft N=83	44% (34/78)		51% (42/83)		Cure group: 17    (12-30) Failure group: 17    (5-38) …

…  Failures are reported at time of clinical exam denoting failure therefore follow-up may

     be < 12 months.

CONCLUSION:  Porcine dermal xenograft and cadaveric fascial allograft when used for suburethral slings have significantly higher failure rates as compared to autograft.

Key Words: suburethral sling, autograft, allograft, xenograft, urinary incontinence

Disclosure -Speaker Bureau: CR Powell, Pfizer; SA Menefee, Boston Scientific.