Stress urinary incontinence  (SUI) due to neurogenic intrinsic sphincter deficiency is a common issue in patients with spina bifida. Autologous fascial sling is one of the most interesting surgical options in these patients owing to the poor efficacy and high risk of mesh related complications with synthetic miduretrhal slings. Rectus fascia harvesting carries a high risk of wound complications especially in obese patients and in those with multiple previous adominal surgeries. The aim of the video was to describe a technique of pubovaginal sling using the fascia lata instead of the rectus fascia

We present the case of a 22 years-old female with myelomeningocele and SUI. She is self-catheterizing and treated with repeated intradetrusor botulinum toxin injections due to neurogenic detrusor overactivity. On physical examination, SUI is demonstrated with a fixed urethra
She was proposed an artificial urinary sphincter or an autologous pubovaginal sling and elected the later.
A fascia lata sling was chosen because of the obesity of the patient, to minimize the risk of abdominal wall complications.

RESULTS : 
To harvest the fascia lata sling, a 10 cm incision is made on the outer side of the right thigh and carried down to the fascia lata. Two 10 cm parallel incisions are made in the fascia, about 1,5 cm apart. The undersurface of the fascia is dissected and the fascia is excised. 
The aponevrosis is then closed using two running sutures
The sling is prepared and two 2/0 prolene are placed at each end of the sling. 
 
An inverted U incision is made about 2 cm under the urethral meatus. The dissection of the urethra and the bladder neck is carried bluntly until the endopelvic fascia is reached on both side of the bladder neck

A suprapubic 4 cm incision is made down to the rectus fascia which is not opened
The retropubic passages for the sling are created by perforating the rectus fascia and the endopelvic fascia from top to bottom with a clamp while a finger is placed in the vaginal fornix to prevent bladder neck damage. The sling is pulled from the vaginal incision to the abdominal incision The same maneuver is done on the contralateral side. 

A cystoscopy is performed to confirm that no bladder or urethral injury was made. 
The prolene stitches are closed above the rectus fascia, making sure to tighten the sling given the patient is self catheterizing and urinary retention is not an issue

The vaginal and suprapubic incision are closed. 

The operative time was 150 minutes with minimal blood loss. There was no postoperative complications. The patient was discharged on postoperative day 2. The urethral catheter was removed at day 10 and the patient was able to resumed her self-catheterization easily.

Autologous fascia lata pubovaginal sling is a safe and simple surgical technique for female patients with either obesity or multiple previous abdominal surgeries in an intent to minimize the risk of wound complications