Autologous transobturator midurethral sling

Özet

Objective: The aim of this study is to describe a novel transobturator midurethral sling surgery techniqueby using rectus abdominis fascia.Material and methods: A 54-year-old woman complaining of urinary leakage during effort was diagnosed as pure stress urinary incontinence after detailed questioning, pelvic examination, uroflowmetry andmeasurement of residual urine volume. She was anxious about complications related to synthetic meshes.However, she was not interested in relatively morbid surgeries such as colposuspension and pubovaginalsling. Autologous transobturator midurethral sling was discussed with the patient. The patient approved thesurgery and the surgery was planned. A 5 cm rectus fascia was harvested via suprapubic incision and nonabsorbable stay sutures were placed on its’ both edges. Anterior vaginal incision together with paravaginaldissection was performed, as in classical transobturator sling surgery. Groin puncture and blind dissectionof adipose tissue was performed. C-shaped trocars were inserted, and advanced through groin punctures andbrought up to midurethral incision by finger guidance. Stay sutures were transported via C-shaped trocars tothe groin puncture in both sides. Graft was positioned on the midurethral part without any tension and staysutures were tied to create a tissue bridge on obturator membrane. Incisions were closed and vaginal tamponwas placed. Patient was discharged at the first postoperative day.Results: At postoperative third and sixth months, patient was totally dry and did not have any voiding complaints. Small abdominal and vaginal incisions were clean, as well.Conclusion: Autologous transobturator midurethral sling surgery is a safe, effective and feasible surgicaloption for stress urinary incontinence in the era which mesh-related concerns are rising. Studies with largervolume and long-term follow up periods are needed.