Rectus fascia pubovaginal sling for recurrent stress urinary incontinence after failed synthetic mid-urethral sling: Letter.

We were very interested to read the recent study by Welk and Herschorn, and the related commentary by Steele, regarding the role of autologous rectus fascial slings for complex recurrent female stress urinary incontinence (SUI).1,2 The authors report that, on mediumterm follow-up of 33 women with previous failed continence surgery, pubovaginal sling was associated with a significant reduction in pad usage and good patient satisfaction rates.1 In 2010, we reviewed the published literature on therapeutic options for managing women with recurrent SUI after failed synthetic mid-urethral sling (MUS).3 At that time, no studies reporting outcomes after PVS for a previous failed MUS had been reported and thus, the data reported by Welk and Herschorn are particularly welcome. We also recently collected data on women undergoing rectus fascial PVS for complex recurrent SUI in our tertiary urogynecology unit. Preoperative video-urodynamics was performed in all women considering PVS. The surgical technique used was very similar to that by Welk and Herschorn,1 with a 13 × 2-cm strip of rectus fascia harvested. All cases were seen in the clinic at 6 weeks and 12 months postoperatively and at variable follow-up periods thereafter. At follow-up visits, uroflowmetry and post-void residual volume were performed and subjective cure of SUI was assessed. We identified 7 women who underwent PVS after a previously failed MUS, who were contacted by telephone to complete the ICIQ-SF questionnaire4 and to ascertain cure (Table 1). Women had a median age of 61 (range: 41-73) years and were a complex group, with a median of 2 (range: 1-4) prior continence surgeries. All women completed the telephone survey and the median interval since the PVS was 5 years (range: 0.5-9 years). The long-term failure rate following PVS for recurrent SUI in our population was 14% (1/7). This patient had preoperative voiding dysfunction and Colin A. Walsh, MRCOG; Katrina Parkin, RN; Kate H. Moore, MD, FRANZCOG