The autologous fascial sling is often considered mainly as a salvage procedure for stress urinary incontinence, in the setting of failed previous incontinence intervention.  This is partially due to the perception that autologous fascial sling is associated with an increased risk of urinary retention after placement. This perception may prevent surgeons from utilizing it as an initial intervention for stress incontinence. We examined the rates of transient urinary retention with harvest of fascia lata graft and placement of autologous fascial sling, both in autologous fascial sling-only cases, in addition to autologous fascial sling performed with concomitant prolapse repair, in the setting of the hypothesis that patients who undergo concomitant prolapse procedures would be at higher risk for transient urinary retention.

We retrospectively reviewed all autologous fascial sling performed by a single surgeon from August 2016 through October 2020, looking at urinary retention rates in the postoperative setting. Urinary retention was defined as the need for clean intermittent catheterization for greater than two weeks after surgery.

Over 50 months, 116 patients underwent autologous fascial sling placement. Of these, 39 (33%) had concomitant prolapse repair performed. Overall, there were 18 (15%) patients who had urinary retention and had to perform clean intermittent catheterization for more than 2 weeks. Of these, 7 (18%) had a transvaginal prolapse repair performed at the same time as compared to 11 of the autologous fascial sling-only cases (14%). Only 2 of the patients with urinary retention had to undergo urethrolysis with incision of fascial sling, to facilitate self-voiding and alleviate the need for clean intermittent catheterization. One of the two patients requiring sling incision had a transvaginal prolapse repair at the time of autologous fascial sling placement. All remaining patients were able to void spontaneously within 3 months of surgery, without any further need for clean intermittent catheterization.

In our patient cohort, there was a higher risk of transient urinary retention when there was an autologous fascial sling placed concomitantly at the time of transvaginal prolapse repair (18 versus 14%). This may be due to the potentially drastic change in anatomic alignment of not only the anterior compartment but the urethrovesicle junction as well.  There was also one patient in each group that required incision of the fascial sling to allow for volitional voiding, alleviating the need for continued clean intermittent catheterization.  This study is limited by its relatively small sample size and retrospective nature.

In our patient cohort, it appears that concomitant transvaginal prolapse repair, in the setting of autologous fascial sling placement, increases the risk of transient urinary retention.  However, overall, we demonstrate a very low risk of retention necessitating urethrolysis (less than 2%), both with and without concomitant transvaginal prolapse repair, providing further reassurance for surgeons counseling patients regarding peri-operative risks of placement of autologous fascial sling for stress urinary incontinence.