Autologous fascial slings remain viable at long-term follow-up: a post cystectomy case report.
Autologous fascial slings
Case report
Muscle fascia
Stress urinary incontinence
Suburethral slings
Journal
BMC urology
ISSN: 1471-2490
Titre abrégé: BMC Urol
Pays: England
ID NLM: 100968571
Informations de publication
Date de publication:
08 Sep 2021
08 Sep 2021
Historique:
received:
11
10
2020
accepted:
17
08
2021
entrez:
9
9
2021
pubmed:
10
9
2021
medline:
8
1
2022
Statut:
epublish
Résumé
Autologous fascial slings (AFS) have been used for a very long time in the treatment of female stress urinary incontinence, but the introduction of synthetic mesh slings placed either retropubicallyor trans-obturator has decreased the need to harvest the autologous rectus muscle fascia, thus reducing invasiveness and operative time. However AFS are still indicated in complicated cases and re-interventions, and the FDA has underlined safety concerns over the use of surgical meshes for the transvaginal repair of prolapsed pelvic organs. A 76-year-old woman with muscle-invasivebladder cancer underwent radical cystectomy 16 years after retropubic positioning of an autologous rectus muscle fascial sling for SUI, with complete symptom resolution. The sling was easily identified and removed en bloc with the bladder and urethra, providing an opportunity to histologicallyevaluate the autologous fascial graft after its long permanence in the new position. Histopathological examination demonstrated increased fibroblastic proliferation and formation of capillaries. A slight separation and an increased waviness of the connective fibers were both evident. An increased vascularity was also apparent, including transverse vessels, with clusters of vessels. A relative inflammatory reaction was present in over 300 cells/10 HPF. All these characteristics indicated viable connective tissue. AFS remain a valuable surgical option for both primary and recurrent SUI in women, showing high cure rates and low complications in the long-term. The present case, to the best of our knowledge, presents the longest follow-up period of an autologous rectus muscle fascia placed retropubically and its histological evaluation documents characteristics which support its mechanical strength and viability.
Sections du résumé
BACKGROUND
BACKGROUND
Autologous fascial slings (AFS) have been used for a very long time in the treatment of female stress urinary incontinence, but the introduction of synthetic mesh slings placed either retropubicallyor trans-obturator has decreased the need to harvest the autologous rectus muscle fascia, thus reducing invasiveness and operative time. However AFS are still indicated in complicated cases and re-interventions, and the FDA has underlined safety concerns over the use of surgical meshes for the transvaginal repair of prolapsed pelvic organs.
CASE PRESENTATION
METHODS
A 76-year-old woman with muscle-invasivebladder cancer underwent radical cystectomy 16 years after retropubic positioning of an autologous rectus muscle fascial sling for SUI, with complete symptom resolution. The sling was easily identified and removed en bloc with the bladder and urethra, providing an opportunity to histologicallyevaluate the autologous fascial graft after its long permanence in the new position. Histopathological examination demonstrated increased fibroblastic proliferation and formation of capillaries. A slight separation and an increased waviness of the connective fibers were both evident. An increased vascularity was also apparent, including transverse vessels, with clusters of vessels. A relative inflammatory reaction was present in over 300 cells/10 HPF. All these characteristics indicated viable connective tissue.
CONCLUSIONS
CONCLUSIONS
AFS remain a valuable surgical option for both primary and recurrent SUI in women, showing high cure rates and low complications in the long-term. The present case, to the best of our knowledge, presents the longest follow-up period of an autologous rectus muscle fascia placed retropubically and its histological evaluation documents characteristics which support its mechanical strength and viability.
Identifiants
pubmed: 34496811
doi: 10.1186/s12894-021-00884-7
pii: 10.1186/s12894-021-00884-7
pmc: PMC8424806
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
122Informations de copyright
© 2021. The Author(s).
Références
Eur Urol. 2018 Aug;74(2):191-196
pubmed: 29803585
Urology. 2013 Dec;82(6):1267-71
pubmed: 24139353
Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(6):321-2
pubmed: 9609327
Yonsei Med J. 2016 Sep;57(5):1152-8
pubmed: 27401646
Urology. 2008 Jul;72(1):85-9
pubmed: 18455763
Cochrane Database Syst Rev. 2017 Jul 26;7:CD001754
pubmed: 28743177
J Urol. 1987 Sep;138(3):525-6
pubmed: 3625851
Int Urogynecol J. 2012 Feb;23(2):211-6
pubmed: 21964554
BJU Int. 2015 Jun;115(6):968-77
pubmed: 24961647
Knee Surg Sports Traumatol Arthrosc. 2007 Sep;15(9):1144-9
pubmed: 17279424
Neurourol Urodyn. 2011 Mar;30(3):284-91
pubmed: 21412819
J Voice. 2017 Sep;31(5):605-609
pubmed: 28343804
Low Urin Tract Symptoms. 2020 Jan;12(1):2-7
pubmed: 31407861
Am J Obstet Gynecol. 2000 Oct;183(4):964-6
pubmed: 11035347
Transl Res. 2017 Feb;180:22-36
pubmed: 27543901
Orthop J Sports Med. 2014 Sep 22;2(9):2325967114550274
pubmed: 26535362
Int Urogynecol J. 2012 Jan;23(1):5-9
pubmed: 22086260