Pubovaginal Sling Operation Using Dermal Fat Graft in Female Stress Urinary Incontinence

Jeong, Chan Sang; Jeong, Hee Jong; Rim, Joung Sik

Abstract

PURPOSE: An autologous dermal fat graft has several advantages, over other viable or synthetic sling materials, in expenditure, postoperative complication and biocompatibility of the host. We investigated the success rate and risk factors of a pubovaginal sling, using an autologous dermal fat graft, in female stress urinary incontinence.
MATERIALS AND METHODS
We retrospectively analyzed the medical records of 30 women that underwent a pubovaginal sling, using a dermal fat graft. The preoperative evaluations included: age, Stamey grade, Blaivas type, urodynamic study and previous pelvic operation history. We observed the postoperative results using questionnaire research during the follow-up (cured: no urine leakage and satisfactory, improved: urine leak< or =4 times/week and satisfactory, failed: urine leakage>4 times/week or unsatisfactory). The risk factors affecting the postoperative outcomes and complications were also analyzed.
RESULTS
The success rate was 90.0% (success rate was calculated by cured rate plus improved rate, cured rate: 53.3%, improved rate: 36.7%), with the follow-up periods ranging from 6 to 24 months. A wound infection, requiring hospitalization, developed in one patient, but no other significant complications related to dermal graft were noted. Within the preoperative evaluations, the Blaivas type and a previous pelvic operation history were statistically related to the success rate (p<0.05).
CONCLUSIONS
The Blaivas type and previous pelvic operation history are meaningful factors for predicting the success rate. The use of a dermal fat graft might be beneficial in the treatment of stress urinary incontinence in terms of its cost and success rate. However, a lower abdominal scar, of more than 5cm in length, and postoperative infections remain in some patients. Therefore it might be necessary to find another useful material for to treat female stress urinary incontinence.