Urinary stress incontinence in women is a problem with high prevalence. Treatment options include amongst others physiotherapy, electric nerve stimulation, operative approaches. 
In July 2018, vaginal meshes were banned in the UK due to a large discussion about side effects. Since then, even the TVT (tension free vaginal tape) meshes for incontinence operations are on hold. Other countries acted similarly.
As orthopedic surgeons have reported excellent experience with the 20–30cm long and 1.5cm broad semitendinosus tendon for anterior cruciate ligament reconstruction, we initiated a feasibility study using this tendon to perform a TVT operation without a synthetic mesh. We already used this tendon successfully for cervicosacropexy [2] and pectopexy [3] in women with prolapse.

Patients with stress incontinence were offered a vaginal TVT operation by means of autologous semitendinosus tendon transplantation instead of a synthetic mesh. In this feasibility trial 40 patients are planned to be treated with this technique. 
A tendon of the patient's semitendinosus muscle was removed through a 3cm incision in the back of one knee. After placing a resorbable suture to both ends of the tendon it is used instead of a synthetic tape as midurethral sling, as it is done in a classical retropubic TVT procedure.
The patients are asked to fill out the German version of the KOOS questionnaire for evaluating the knee functioning before the operation, 6 weeks and 6 months after the operation.

Up to now we have operated 4 patients with this technique. All of them were performed successfully without intraoperative complications. Recovery was fast, and discharge was possible the next day. 
In the very first patient a urinary retention was seen after three months [1]. In her the tendon was incised in local anesthesia and the problem solved. Since then (08/2019) she is continent without further problems. In a telephone interview in 02/2021, she said that she is still happy and would recommend the method to other affected women. 
The other operations were done within the last 5 months. In them the tendon was placed less tight and they described continence too but no urinary retention. In all four patients the mobility and the power of the affected leg did not change.

Our approach demonstrates the feasibility of a TVT procedure with a semitendinosus autograft instead of a synthetic mesh. As the operation is just a combination of two very established procedures (tendon transplantation, TVT) we see potential that a semitendinosus tendon become a new material for women with incontinence.

Tendon incontinence repair - First experience with an autologous semitendinosus tendon transplant for urinary stress incontinence treatment. Hornemann A, Hoch B, Franz W, Sütterlin M. Urol Case Rep. 2020 May 21;32:101257. doi: 10.1016/j.eucr.2020.101257. eCollection 2020 Sep.
Hamstring Autograft as a Mesh Alternative for Pelvic Organ Prolapse. Hornemann A, Hoch B, Germann G, Franz W, Sütterlin M. J Minim Invasive Gynecol. 2020 Jan;27(1):17-18. doi: 10.1016/j.jmig.2019.05.018. Epub 2019 Jun 5.
Tendon Descensus Repair (TENDER) - A prospective clinical feasibility study of tendon transplantation for pelvic organ prolapse repair. Hornemann A, Hoch B, Hofmann J, Franz W, Sütterlin M. Eur J Obstet Gynecol Reprod Biol. 2020 Jun;249:37-41. doi: 10.1016/j.ejogrb.2020.04.035. Epub 2020 Apr 18.