Stress urinary incontinence (SUI) have severe negative impact on the quality of life in women. Although synthetic mid-urethral sling surgery has been considered as the standard surgical treatment worldwide, artificial mesh related complications become an important issue in several countries. The old-fashioned usage of rectus fascial sling is an alternative to reduce adverse events. We evaluated the treatment outcome of modified autologous trans-obturator fascial (TOF) sling operation applied to the female patients with stress urinary incontinence.

Between 2017 and 2020, 33 SUI patients received the modified mid-urethral TOF and were recruited in this retrospective study. All questionnaires, including Urinary Distress Inventory, Short Form (UDI-6), Incontinence Impact Questionnaire, Short Form (IIQ7), Overactive Bladder Symptom Score (OABSS), were collected at the timepoint before and after sling surgery. Treatment outcome, like Clinical Global Impressions scale- Improvement (CGI-I) was evaluated and recorded after operation. The data of common adverse events were also recorded. The paired samples t-test was applied to compare the scores of all questionnaires between pre-operative and post-operative timepoint.

Of all 33 female patients, the mean patient age was 59.76 years old (range from 39 to 79 yrs). All the pre-operative total score of UDI-6, IIQ-7, and OABSS  (11.55±5.47, 10.21±5.79, and 6.06±4.03, respectively) showed statistically significantly decrease after operation (3.67±3.72, 0.85±3.67, 3.06±2.90 respectively, p < 0.001). Each sub-score of UDI-6 was further analyze and presented significantly improvement in symptoms of frequency (from 2.03±1.70 to 0.79±1.11, p< 0.001), urge urinary incontinence (from 1.79±1.69 to 0.52±1.09, p< 0.001), and stress urinary incontinence (from 3.61±0.75 to 0.55±1.00, p< 0.001). The mean total score of CGI-I was 2.00 ± 0.80. Of total 33 patients, 18 patients have no significantly decreasing maximal flow rate after receiving sling surgery (p=0.804). Regarding the complications of surgery, there are two patients (5.88%) reported voiding dysfunction, one patient (2.94%) inguinal pain and one patient (2.94%) mild erosion after operation.

The patients received the modified mid-urethral TOF can relieve their symptoms significantly according to the score of UDI-6, IIQ7, OABSS, and CGI-I.  According to sub-score of UDI-6, the patients got significant improvement of freuquency, urge urinary incontinence, and stress urinary incontinence. 18 of 33 patients received pre-operative and post-operative maximal flow rate, and presented no significant impact on maximal flow rate. Furthermore, there were few complication in the 33 patients, like voiding dysfunction, inguinal pain, or mild erosion.

Modified TOF sling surgery is feasible and an alternative treatment for SUI patients. In addition to significant improvement in urinary continence, few post-operative complications were reported in this study.