ABSTRACT
Early in their inception, pubovaginal bladder neck slings (PVSs) were primarily reserved for the treatment of refractory stress urinary incontinence (SUI). However, owing to an improved understanding of SUI pathophysiology and the introduction of several technological advancements, the pvs has become the surgical gold standard for women who suffer from uncomplicated or complicated sui. The ideal material for the construction of a pubovaginal sling is sterile, biocompatible, noncarcinogenic, and consistent in quality. In the literature, several allograft, xenograft, and synthetic materials meeting these criteria have been studied. Allograft and xenograft materials are not commonly used for pubovaginal slings because of questions about their durability and cost. Most synthetic materials are made out of polypropylene mesh. In addition, while synthetic meshes are certainly durable, they do carry the potential drawbacks of higher rates of graft infection, urinary tract perforation, and vaginal exposure. Outcomes data have shown that synthetic pubovaginal slings are 15 times more likely to perforate into the urethra (0.02%) and are exposed 14 times more often in the vagina (0.007%) compared to autologous slings [1,2]. For these reasons and others, autologous fascial slings remain the material of choice. Their use and outcomes will be the focus of this chapter.
