Stress urinary incontinence (SUI) is defined as the involuntary passage of urine resulting from  increased intra-abdominal pressure, and it affects a significant proportion of women, ranging from  18% to 26.4% (1). Several factors can predispose individuals to SUI, including childbirth trauma,  obesity, conditions that lead to persistent raised intra-abdominal pressure such as abdominal masses, chronic constipation and chronic coughing (2).
The  management  approach  for  mild  to  moderate   SUI   is  conservative,  involving  lifestyle modifications such as weight loss, fluid and diet adjustments, supervised pelvic floor exercises, weighted vaginal cones and mechanical devices and inserts  (3). In  cases where  conservative treatment   fails   or   surgery   is   pending,   medical   management   with   selective   serotonin   and norepinephrine reuptake inhibitors (SNRI) like Duloxetine can be administered for a duration of 8- 12  weeks. However,  surgical  intervention  is  necessary  for  patients  suffering  from moderate to severe SUI (1, 2).
Previously, Kelly's plication was utilized for patients experiencing stress urinary incontinence (SUI) during vaginal hysterectomy; however, it had limited long-term success [2]. Consequently, other surgical procedures have gained attention, such as open or laparoscopic Burch colposuspension. Mid urethral slings have since emerged as a viable option using either autologous or synthetic material.  Synthetic  mesh  was  once  popular  but  became infamous because of mesh related complications. Autologous fascia has regained prominence as an alternative approach.

The procedure for autologous fascia lata sling surgery is as follows:
Patient positioned in high lithotomy position, and fascia lata (The landmark for harvesting fascia is 4-5cm anterior and parallel to the sulcus between vastus lateralis and biceps femoris muscle, 15 cm inferior to  anterior  superior  iliac  spine  and  10  cm  superior  to  lateral  femoral  condyle) will be harvested from thigh by giving a short transverse incision 2 fingers above the knee joint along the course of fascia lata. Approx 15*2 cm Fascia lata was cut from below and divided at upper end. Complete hemostasis achieved. The skin edges were closed, and compression bandage  applied on thigh. Non-absorbable (prolene) sutures were put at each end of harvested fascia lata. At the vaginal end, 2 cm vertical incision was given starting from 1 cm below urethra and dissection done on both the sides till inferior pubic rami reached. Points marked on the skin at the level of clitoris, just lateral to inguinocrural folds and transobturator outside in needle inserted through the marked point and brought out into the dissected space in vagina. Prolene sutures at the end of fascia lata passed through the eye of the needle, and the needle rotated back and brought out from skin. Similar procedure repeated on other side. The ends of the sling pulled to adjust the tension by keeping one artery forceps between urethra and sling. Overlying vaginal mucosa is closed. Foley’s catheter is kept in situ for 24 hours post procedure.

Operating time was 75 minutes total. No intraoperative or immediate postoperative complications were noted. Foley's catheter was removed after 24 hours. Patient could void urine comfortably, no voiding dysfunction. She was discharged on postoperative day 2.

Autologous fascia lata sling surgery is an effective technique for treatment of female stress urinary incontinence. The cost and complications of mesh are also avoided.

Haylen, B. T, de Ridder D, Freeman, R. M,  Swift,  S. E, Berghmans, B, Lee, J, Monga, A, Petri,  E,  Rizk,  D.  E,  Sand,  P.  K,  &  Schaer,  G.N.  An  International  Urogynaecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. International urogynaecology journal, 2010; 21(1):5–26
Shamliyan  T, Wyman  J, Bliss DZ, Kane RL, Wilt  TJ. Prevention  of urinary  and  fecal incontinence in adults. Evid Rep TechnolAssess (Full Rep). 2007; (161):1-379.
Ayeleke RO, Hay-Smith EJC, Omar MI. Pelvic floor muscle training added to another active treatment  versus  the  same  active  treatment  alone  for  urinary  incontinence  in  women. Cochrane Incontinence Group, editor. Cochrane Database Syst Rev. 2015(11).