Like a synthetic midurethral sling, an autologous fascial sling is placed under the urethra. It supports the pelvic floor muscles and helps the urethra resist increases in abdominal pressure transmitted to the bladder.
This sling is placed either at the mid urethra or nearer to the bladder, and no synthetic material is used (see Fig. 4). The sling is made from your own connective tissue, called fascia, taken from the lower belly or thigh. Removing this tissue creates additional wounds.
Autologous fascial slings and synthetic midurethral slings have similar effectiveness. Autologous fascial slings can have a slightly higher risk of complications, especially difficulty emptying the bladder.
When should I consider an autologous fascial sling?
An autologous fascial sling is a good alternative if a synthetic midurethral sling cannot be used, or if you want to avoid synthetic material. It is also an option if previous surgery for SUI didn’t work.
How is an autologous fascial sling implanted?
You will typically be unconscious (general anaesthesia) for this procedure. Spinal anaesthesia can also be used to block nerve response to pain.
- The bladder is emptied. The surgeon will insert a catheter to make sure that your bladder is completely empty during surgery.
- Connective tissue is harvested. A cut, typically horizontal, is made a few centimetres long in the lower belly. A strip of fascia is taken from the rectus muscle. This strip is typically more than 8 cm long and 1.5 to 2 cm wide. Then the fascia is closed.
- The sling is placed. The surgeon makes a small cut in the front of the vaginal wall. The fascial strip is placed under the urethra near the bladder. The two ends of the sling are brought to the lower belly area using a special instrument and attached just above the pubic bone (retropubic route). The sling is secured using suture material.
- The inside of the bladder is examined (cystocopy). The surgeon will look through your urethra into your bladder using a very small camera to rule out injury to the bladder.