Efficacy of the autologous fascial sling in the neuropathic population
BAUS ePoster online library. Downey A. Jun 26, 2018; 211331
Ms. Alison Downey
Ms. Alison Downey
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Abstract
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Introduction: Neuropathic stress urinary incontinence is a common and debilitating problem; particularly in severely disabled patients with sacral pressure sores. NICE recommends insertion of autologous fascial sling over synthetic tapes due to the risk of urethral erosion. We performed a retrospective review of patients undergoing AFS in a single specialised centre to assess outcomes.

Patients and Methods: 14 patients were identified with a median age of 47 (range 19-80). 11 had a spinal cord injury and 3 a supra-pontine condition. 3 patients had severe sacral pressure ulcers complicated by severe incontinence. All patients underwent preoperative urodynamics which demonstrated SUI and completed pre- and post-op ICIQ questionnaires. 6 patients had had previous intervention for SUI and 5 were on treatment for neuropathic overactivity preoperatively.

Results: Median length of stay was 2.5 days. 7 patients had a concurrent procedure and 3 required intraoperative repositioning of sling. 1 patient returned to theatre for washout of haematoma. All patients were dependent on catheterisation as expected (4 with SPC and 7 doing ISC). 2 patients developed de novo overactivity. Mean ICIQ score decreased from 17 to 0. Mean pad usage decreased from 5 pads per day to 0 pads per day with 8 patients completely dry. The 3 patients with sacral pressure ulcers were completely dry and therefore proceeded to definitive management of their sores.

Conclusion: Autologous fascial sling insertion in our unit had excellent results with acceptable complication rates; all patients had an improvement in symptoms and a decrease in pad usage.
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