Stress urinary incontinence (SUI) is the most common type of urinary incontinence in women. When conservative measures fail, surgery is indicated. Due to the mesh related complications, current guidelines recommend the patients to be offered all surgical options including colposuspension, bulking agents, autologous fascial slings and synthetic slings. For women with SUI and urethral hypermobility, first line surgical treatment for women with SUI is an autologous or synthetic sling procedure after a careful discussion with the patient. Here we review the short- term outcomes of surgery performed using autologous fascia or synthetic mesh.

Patients being treated for SUI at a tertiary referral centre between January 2021 and March 2024 were retrospectively examined. Each patient received pelvic floor exercises for at least 6 weeks and/or medical treatment Those who failed conservative measures were counseled for surgical treatment using either an autologous fascia sling (AFS) or a synthetic mesh sling (SS). After a through discussion on pros and cons of each option patients made the final decision. Both the synthetic mesh and autologous fascia were placed via the retropubic route at the level of mid- urethra following standard techniques. A transobturator tape (TOT) was only performed when retropubic route was not available. The patients' clinical information, surgical technique, postoperative success and complication conditions were noted.

The median age of the patients was 56 (42-73) years and the median follow-up period was 8 (1-30) months. A total of 41/52 (78.8%) patients underwent AFS, 7/52 (13.5%) patients underwent TOT, and 4/52 (7.7%) patients underwent transvaginal tape (TVT). Complete dryness was achieved in 81.8% (9 / 11) and 78.7% (33/ 41) of patients with SS and AFS, respectively (p=1,000). The median hospital stay was 2 and 1 days in the AFS and SS groups, respectively. In the AFS group 1/ 41 (2.4 %)  patient had mechanical sling failure, 3/41 (7.3%) patients required temporary ISC (<6 weeks),  3/41 (7.3%) patients had wound infection. and 1/ 41 (2.4 %)  patient underwent sling release. Two (4.8%) patients received botox injection into the bladder in the postoperative period due to de novo urgency.

Compared to synthetic slings, patients who undergo autologous sling surgery have a longer hospital stay and a higher rate of complications. Nevertheless, the majority of patients prefered an autologous sling instead of a synthetic one possibly due to concerns about the long- term safety of the synthetic tapes.

In stress urinary incontinence, autologous or synthetic sling operations can be performed with satisfactory results in the short term.

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