Urinary retention after autologous fascial sling placement: a randomised trial comparing adjustment techniques.

Abstract

To evaluate the incidence of early postoperative urinary retention after autologous fascial sling (AFS) placement in women with stress urinary incontinence (SUI), comparing two graft adjustment techniques. This randomised controlled trial enrolled 53 women with SUI, who were randomly assigned to undergo the retropubic sling procedure with one of two different AFS adjustment techniques: Group A (3-cm knot-aponeurosis interval) and Group B (6-cm interval). The primary outcome was urinary retention within 12 weeks, defined as the need for catheterisation or a post-void residual urine volume of >200 mL. Secondary outcomes included continence rates, patient satisfaction, and postoperative complications. In all, 52 of the 53 enrolled patients completed the 12-week follow-up: Group A (n = 27) and Group B (n = 25). The mean age was 59 years, and 75% had mixed UI symptoms. Urinary retention occurred in 14 patients (26.9%) within 2 weeks: nine (33.3%) in Group A vs five (20%) in Group B (P = 0.28). By Week 4, retention persisted in four (14.8%) and two (8%) patients, respectively (P = 0.44). Five underwent sling division, which resolved symptoms in four cases. At final follow-up, one patient per group remained catheter dependent (P = 0.96). The overall subjective continence cure rate was 65.4%, while the objective cure rate reached 82.7%. In global assessments, 33 patients reported significant improvement, while 11 noted slight improvement. De novo storage symptoms (7.7%), graft-site complications (13.4%), and urinary tract infection-like symptoms (19.2%) showed no significant differences between the groups. There were no significant differences in urinary retention, continence rates, patient satisfaction, or complications between the two AFS adjustment techniques.