Stress urinary incontinence (SUI) as defined by the International Continence Society (ICS) is “the complaint of any involuntary loss of urine with activities causing increased abdominal pressure like sneezing, coughing, laughing, climbing stairs, sporting activities etc(1). There are various surgical treatments for SUI of which autologous tissue pubovaginal sling is one of the techniques. Historically autologous fascial pubovaginal slings (AFPVS) were introduced almost a century back by Goebell in 1910 and Aldridge in 1942 but were popularised by McGuire and Lytton in 1978 who standardized the technique of use of rectus fascia sling as pubovaginal sling with 80% success rate(2)(3).

This was a case of 45 years old patient with SUI who underwent autologous rectus facsia pubovaginal sling. Transverse abdominal incision given 2 cm above the pubic symphysis and abdomen was opened in layers till rectus fascia is reached. Graft of rectus fascia taken 8 cm in length and 2 cm in breadth and kept in a solution containing 4 mg Inj. Dexamethasone, 5000 IU Inj. Heparin and 80 mg Inj. Gentamycin in 100 ml normal saline. Stay sutures taken at both the ends of the graft using no.1 Prolene suture. Dissection done transabdominally in the space of Retzius. Simultaneously, at the vaginal end, midline vaginal incision of 2 cm given just below the urethra, and vaginal wall dissected from underlying urethra and dissection done till inferior pubic ramus on each side. Kelly’s clamp was inserted through the abdominal incision in the space of Retzius and brought out at the vaginal end. Each sling arm was passed from vaginal end to abdominal end using the Kelly’s clamp. The central portion of the sling was placed at the mid urethral level. The prolene suture at the end of sling (sling arm) were brought out through the lower leaf of rectus fascia on both the sides. Rectus was closed using loop nylon. At the vaginal end, a Kelly’s clamp was placed between the urethra and the sling and sling pulled through the abdominal end. The two prolene sutures were tied to each other and tightened over a Kelly’s clamp. Vaginal incision was closed using 1-0 Vicryl in a continuous fashion. Abdomen closed in layers.

Total operative time was 60 mind. Patient stood the procedure well, catheter was removed on post operative day 5. Patient could pass urine and had no complaints or complications. On 6 months follow up, she had no complaints of SUI.

Autologous rectus fascia pubovaginal sling surgery requires long operative time and postoperative catheterization and care for 5 days, but is a good surgical technique for treatment of SUI.

Haylen BT et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Neurourol Urodyn 2010; 29:4–20.
Bayrak O, Osborn D, Reynolds WS, Dmochowski RR. Pubovaginal sling materials and their outcomes. Türk Ürol DergisiTurkish J Urol. 2014 Dec 10;40(4):233–9.
Mahdy A, Ghoniem GM. Autologous rectus fascia sling for treatment of stress urinary incontinence in women: A review of the literature. Neurourol Urodyn [Internet]. 2019 Aug [cited 2019 Nov 26];38(S4). Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/nau.23878