What is an autologous fascial sling?

An autologous fascial sling procedure is an operation to help women with stress incontinence, the leakage of urine when coughing, sneezing or moving.

How does it work?

This procedure involves making a sling from your own natural tissue. Fascia, a layer of strong connective tissue beneath your skin, is harvested from your abdominal wall (tummy). This fascial sling is then used to support your urethra.

Normally, the urethra is supported by the pelvic floor muscle to maintain a tight seal and prevent involuntary urine loss. In women with stress incontinence, the weakened pelvic floor muscle and connective tissue can't support the urethra in its normal position.

Is this procedure suitable for all women with stress incontinence?

It is suitable for women who leak because of stress incontinence - urinary incontinence that occurs with activity such as running, laughing, sport and walking. The cause of urine leakage can usually be diagnosed by performing a urodynamic test; this is carried out on all women before the sling operation is performed.

An autologous fascial sling procedure is appropriate in women with previous mesh complications related to the synthetic sling procedures. It is also appropriate for anyone keen to avoid mesh implant. However, Oxford gynaecology's surgeons recommend the TVT synthetic sling to the majority of their patients because extensive clinical use has shown it to be a very effective, low risk procedure.

A sling operation is usually not recommended for a woman who may want to have a further pregnancy, as this may cause the woman to become incontinent again.

How successful is the autologous sling procedure?

Reported success rates vary between 70% and 95%. However, the satisfaction rate is lower in women who have had previous surgery for stress incontinence or who have other bladder problems, such as an overactive bladder or difficulty emptying their bladder.

How is the autologous sling procedure performed?

The procedure can be performed using either a general anaesthetic or a regional (spinal) anaesthetic.

A 6 to 8cm cut is made in your abdomen just above the pubic bone to harvest the fascial sling. Another small 1-2cm cut is also made inside your vagina. The fascial sling is then placed around the urethra providing the support and preventing urinary leakage. The sling stays in place permanently.

A telescope (cystoscope) is inserted through the urethra into the bladder to make sure that there is no bladder injury. Dissolving stitches are placed in the incisions.

What is the recovery after surgery like?

Most women spend one or two nights in the hospital after the operation. The patient goes home when the nurses are happy that she is emptying her bladder well, any vaginal bleeding is not heavy and any discomfort is controlled. The effects of the anaesthetic will usually wear off after 24 hours. There will then be some discomfort at the operation site and the patient will need to take painkillers for several days. Paracetamol and/or Ibuprofen (Nurofen) are usually sufficient.

Most women need six weeks off work, or eight weeks if the job is strenuous. Heavy lifting should be avoided for six weeks.

Further information

For more information about recovering from the operation, and what to expect on going home, read our information leaflets: Autologous fascial sling

External links

A natural sling supporting the urethra