Comparison of autologous rectus fascia and cadaveric fascia in pubovaginal sling continence outcomes

Objective The purpose of this study was to compare autologous versus cadaveric grafts in pubovaginal slings. Study design Women who had pubovaginal slings from 1994 to 2003 completed history, questionnaires, prolapse staging, and cough stress testing. Failure was defined by recurrent urinary incontinence symptoms and reoperation for stress incontinence. Group differences were evaluated using Student t test or chi-square test. The log-rank test was used to evaluate time to failure between the groups. Results Of 303 women enrolled, 153 had autologous and 150 had cadaveric grafts. Regular urine leakage (39.6% vs 28.3%, P = .04) and reoperation for stress incontinence (12.7% vs 3.3%, P = .003) occurred more in the cadaveric versus autologous group, respectively. Adjusting for differing follow-up times, the cadaveric versus autologous group experienced higher rates of urinary incontinence (16 vs 5 per 100 women-years, P< .0001) and higher rates of reoperation (4 vs 1 per 100 women-years, P< .0003). Conclusion Autologous grafts used in pubovaginal slings have superior continence outcomes compared with cadaveric fascia.