Tensor Fascia Lata Pubovaginal Sling for Incontinence
Stress urinary incontinence (SUI) is the leakage of urine with physical stressors, such as coughing, sneezing, laughing or with exercise, causing abdominal pressure to increase. When leakage is minimal and not disruptive to activities of daily living, patients may be satisfied with relief from kegel exercises or pelvic floor physical therapy. The mainstay of treatment for SUI at Austin Urogynecology is a mid-urethral sling, or TVT. The synthetic polypropylene sling placed during a TVT treats unwanted leakage by providing support to the urethra during episodes of stress. Another approach to treatment is an autologous pubovaginal sling using the tensor fascia lata from the upper thigh. Prior to the TVT, an autologous sling using the fascia lata or anterior abdominal wall fascia was the gold standard procedure for incontinence.
The fascia lata sling is done in 2 major steps. The first step is harvesting a 1-2 centimeter strip of fascia lata from the thigh through two small incisions. The next major step is placement of the sling. A small incision is made in the vagina and above the pubic bone. Through the vaginal incision, the urethra is identified and mobilized. The harvested fascia lata is placed around the urethra and tensioned to provide support to the mobilized urethra. The ends of the fascial strip are passed into the retropubic space (behind the pubic bone) and sutured to the abdominal wall fascia. The abdominal incision and the small incision in the vagina are closed with absorbable sutures. The fascial graft provides a permanent support to the urethra to treat and prevent stress urinary incontinence. The procedure takes about 2 hours and patients typically go home the same day or the day after surgery. If the sling is performed in combination with a vaginal prolapse repair or sacrocolpopexy, patients will stay in the hospital overnight and usually go home on post op day one. Restrictions after surgery include vaginal rest for 6 weeks to allow the incision to heal and no heavy lifting or vigorous exercise for the first 2 weeks following surgery.
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