Autologus Fascial Sling

You have been provided this leaflet because you are considering having the Autologus Fascial Sling procedure to treat your urinary stress incontinence. This leaflet will provide you with more information regarding your condition, the procedure and what to expect in hospital.

What is Urinary Stress Incontinence?

Urinary Stress Incontinence (USI) is when you leak urine when increased abdominal pressures occurs, such as exercising, coughing, laughing or sneezing.

USI can occur when there are weak muscles in the pelvic floor or a weaken sphincter muscle at the neck of the bladder.

What is the Autologus Fascial Sling?

The autologous fascial sling procedure is surgical treatment option for urinary stress incontinence. Autologus refers to material taken from your own body and fascia is a sheet of fibrous tissue that hold organs in their correct position. This is the material taken from your abdomen to create a sling under your urethra.

You will be asleep for the procedure. A small incision on your lower abdomen will be made to allow access for removal of the fascia. Once this is removed, a small incision under the urethra will be made in order to thread the fascial sling under for support.

At the end of the procedure, a small camera will go into the urethra and bladder to ensure that no injury has occurred.

What happens at the hospital?

Once your consent has been obtained to proceed with the autologus fascial sling procedure, you will be placed on a waiting list.

You will be required to attend Access Lounge on the day of your procedure. This is where you are admitted, see the nurses and doctors and will wait until you are called for your procedure. Once the procedure is completed in theatres, you will be transferred to a ward for an overnight stay.

The day after your operation, your urinary catheter (that will be inserted during your operation) will be removed and the nurses will ensure you are passing urine successfully and may need to scan your abdomen to ensure enough urine is passing.

Occasionally, your bladder may require more rest and you may go home with a catheter. This will be removed around 5 days after you have been discharged.

You will have a telephone follow up appointment with the Urogynaecology specialist nurse around 3 months after your operation. At this appointment you will be able to discuss your recovery, symptoms and any questions that you may have.

What are the advantages of an autologus fascial sling?

An Autologus fascial sling has the ability to cure or significantly improve USI. This procedure also avoids the need for a mesh material to be implanted.

These are recommendations to trial conservative measures before proceeding with an operation. These should be discussed with your healthcare provider.

What are the associated risks?

For this procedure, you must undergo a general anaesthetic or spinal anaesthetic, this comes with specific risks but this will be discussed in more depth with the anaesthetist. Other general surgery risks such as bleeding, infection, thrombosis and wound complications exist and this can be discussed further with your consultant.

Specific risks to the autologus fascial sling procedure include failure to cure urinary stress incontinence or the recurrence of urinary stress incontinence, after a period of being asymptomatic.

This means symptoms of urinary stress incontinence may return after a period of no symptoms.

There is a risk that having this procedure may cause overactive bladder symptoms, which is frequency of urination or urgency, with leaks or without. Treatment for this can be arranged if this occurs.

Some women may experience difficulty emptying their bladder after the operation. This may present as incomplete bladder emptying or difficulty passing urine. If this occurs you may be required to self-catheterise until this resolves.

If you are interested in learning self-catheterisation prior to your operation please let your consultant or specialist nurse know.

Risks such as bladder injury or injury to other structures exist, such as incisional hernia (hernia at the operation site scar). These will be discussed in more detail with your healthcare provider.

Are there any alternative treatments?

NICE guidance recommends that patients with urinary stress incontinence undergo conservative measures such as lifestyle changes, weight management and fluid education as well as pelvic floor muscle training for a period of 3 months before proceeding with further treatments. These options can be declined by yourself.

There are alternative treatment options such as urethral bulking (Bulkamid) and colposuspension. If further information is required on these options please ask your nurse.

It is important to remember there is the option of having no treatment and managing your symptoms.

Before proceeding with the autologus fascial sling, you will have a test called Urodynamics, this is completed in the outpatient setting and gives your doctor or nurse more information regarding your bladder.

Your case and urodynamic assessment will be discussed at an MDT (multidisciplinary team meeting) to ensure this operation is the best treatment option for you.

Associated Leaflets

• NICE (Surgery for stress urinary incontinence, patient decision aid)

• British Society of Urogynaecology (Autologous fascial sling to treat stress urinary incontinence)

• International Urogynaecology Association (Stress Urinary Incontinence)

• International Urogynaecology Association (Urethral Bulking for Stress Urinary Incontinence)

• International Urogynaecology Association (Pelvic Floor Exercises)

• International Urogynaecology Association (Intermittent Self Catheterisation)

• International Urogynaecology Association (Cystoscopy)

Contact numbers

Urogynaecology Secretary

01642 624 216

Tuesday to Thursday; 8:00am to 4:00pm

Friday; 8:00am to 1:00pm

Gynaecology Secretaries

01642 383 838

Monday to Friday; 8:00am to 4:00pm

Urogynaecology Specialist Nurse

07760 554 010

Monday to Friday; 8:00am to 4:00pm

Please be aware these are not emergency contact lines and if you require immediate medical attention to contact 111 or 999.

Further information

www.BSUG.org.uk

www.RCOG.org.uk

www.yourpelvicfloor.org/leaflets

https://www.nhs.uk/conditions/urinary-incontinence/surgery/

References

British Society of Urogynaecology – Autologous fascial sling to treat stress urinary incontinence.

NICE – Surgery for stress urinary incontinence Patient Decision Aid; https://www.nice.org.uk/guidance/ng123/resources/surgery-for-stress-urinary-incontinence-patient-decision-aid-pdf-6725286110

International Society of Urogynaecology; Stress Urinary Incontinence.

Stress Urinary Incontinence

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