Stress urinary incontinence (SUI) is a common condition affecting one in three women. Autologous fascial sling (AFS) surgery is a surgical option when conservative management fails. This study aimed to evaluate the outcomes of AFS surgery in patients with SUI and to highlight how patient selection, surgical techniques, adherence to protocols, multidisciplinary team (MDT) involvement, and informed decision-making improved outcomes.

After obtaining approval from the Institutional Review Board, we evaluated a total of four female patients who underwent autologous recto fascial sling surgery for SUI between January 2020 and March 2024. All patients met the criteria for uncomplicated SUI. Exclusion criteria included pregnancy, history of pelvic radiation, increased post-void residual volume (PVRV), poor voiding patterns on uroflowmetry, and history of neurological diseases.
Patients were encouraged to engage in lifestyle modifications and pelvic floor muscle training for at least three months following the diagnosis of SUI. Surgery was indicated for those who were reluctant to or dissatisfied with conservative management. The available surgical options and concerns about synthetic meshes were discussed with the patients using shared decision-making tools and after discussions at multidisciplinary meetings.
Design - Retrospective study- Service evaluation Project

The mean age of patients was 42.5 years (± 8.38), with an average BMI of 27.5 kg/m² (± 4.64). All patients showed significant improvement in ICIQ-SF scores, from a baseline of 19.25 (± 2.06) to 3.33 (± 3.51) at 3 months (p=0.029). One patient developed temporary voiding dysfunction, which resolved after several months. No recurrences were reported, and no patients required re-referral. One patient passed away due to unrelated advanced-stage gastrointestinal cancer.

According to the BSUG national report, 160 patients underwent autologous fascial sling (AFS) surgery for Stress Urinary Incontinence (SUI) across 111 centers, encompassing teaching hospitals, district hospitals, and private hospitals (6). This equates to an average of 1.4 surgeries per year per unit. (1) Our district hospital unit performed 4 cases over four years, even amidst the COVID-19 pandemic, with appropriate involvement of the multidisciplinary team (MDT) and adherence to NICE and BSUG guidelines.
Our study demonstrated a subjective cure rate of 100% according to ICIQ-SF scores and improvements in quality of life (QoL) scores. These results are consistent with those of studies with up to two years of follow-up; however, longer-term studies are needed for further comparison. Notably, no patients in our study reported worsened urgency complaints.

The BSUG national report highlights significant variability in the number of autologous fascial sling surgeries performed across UK centers, with an average of 1.4 surgeries per unit annually. Our district hospital conducted four cases in four years, adhering to MDT involvement and BSUG guidelines, even during the COVID-19 pandemic. Objective and subjective cure rates for AFS and TOT procedures remain high, with minimal reported complications. Our findings, demonstrating a 100% subjective cure rate and low incidence of urinary retention, underscore the effectiveness and safety of these procedures, while highlighting the need for longer-term follow-up studies for comprehensive assessment.

BSUG 3 rd National Report
Urinary incontinence and pelvic organ prolapse in women: management, NICE guideline [NG123]Published: 02 April 2019 Last updated: 24 June 2019
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).