Modified Autologous Fascial Sling Insertion Using TVT Technique in a Resource-Poor Setting

Authors: Wedisha Gankanda, Fahim Samsudeen , N.Kulathunga Base Hospital, Balangoda, Sri Lanka

Background

• Stress urinary incontinence (SUI) is a common and distressing condition that affects 38–55% of menopausal women, often leading to a significant decline in quality of life. In women where conservative management fails, surgical treatment is considered. Traditionally, colposuspension and mid-urethral slings (MUS)— particularly the tension-free vaginal tape (TVT)—have been standard surgical options.

• However, synthetic slings carry notable risks such as mesh erosion, migration, infection, and voiding dysfunction, particularly due to excessive tension. These complications may necessitate revision surgeries, which are often not feasible in resource-limited settings.

• Autologous fascial slings offer a mesh-free alternative with lower foreign body-related complication rates. However, their lack of postoperative adjustability remains a limitation, particularly in cases where the initial sling tension is either inadequate or excessive.

Objective

To introduce and describe a modification of the autologous fascial sling insertion technique using the retropubic TVT approach, enabling postoperative adjustment of sling tension. This innovation aims to minimize complications and reduce the need for reoperations in low-resource healthcare environments.