Editing Functional: Female SUI (section)

====== Pubovaginal Sling Materials ======
* '''Options (4):'''
*#'''Autologous'''
*#'''Allograft'''
*#'''Xenograft'''
*#'''Synthetic''' 
*#* Although there is complete biocompatibility of the autologous sling and negligible urethral perforation, biologic graft and synthetic prosthetic materials have been increasingly used to decrease operative time, morbidity, pain, and hospital stay
* '''<span style="color:#ff0000">Autologous fascia PVS'''
** '''<span style="color:#ff0000">Gold standard for management of ALL forms of SUI'''
** '''Advantages compared to alternative sling materials (2):'''
**# '''Minimal tissue inflammation'''
**# '''Negligible risk of urethral erosion'''
** '''Disadvantages compared to alternative sling materials (4):'''
*** '''Increased operative time, hospital stay'''
***'''Postoperative pain'''
***'''Risk of suprapubic wound seroma'''
***'''Risk of incisional hernia'''
** '''<span style="color:#ff0000">Most commonly used autologous materials (2):'''
**# '''<span style="color:#ff0000">Rectus abdominis fascia harvested from the abdominal wall'''
**#* '''<span style="color:#ff0000">Most commonly used'''
**# '''<span style="color:#ff0000">Fascia lata harvested from the lateral thigh'''
**#* '''Fascia lata is the preferred autologous material for PVSs in patients with a history of prior ventral hernia repair;''' unlike rectus facia''',''' the recovery time is less and there is no risk of future abdominal hernia formation.
**#* Disadvantages of fascia lata compared to rectus abdominis:
**#*# Requires repositioning of the patient
**#*# Increased operative time
**#*# Operating in an area unfamiliar to most pelvic surgeons
**# '''Rectus abdominis fascia vs. fascia lata PVS: similar improvement of SUI'''
* '''Allograft PVS'''
** Were introduced in an effort to reduce overall morbidity, operative time, and pain related to graft procurement
** Currently derived from either cadaveric fascia lata or acellular human dermis
** Allografts from cadavers raise the concern of potentially transmitting illnesses such as HIV, hepatitis, and Creutzfeldt-Jakob prion disease
*** The estimated risk of HIV transmission from an allograft is 1 in 1,667,600.
*** The theoretical risk of developing Creutzfeldt-Jakob disease from a non-neural allograft is 1 in 3.5 million.
** '''Tissue-processing techniques for allografts may disrupt the microstructure and affect their strength properties'''
*** '''Maximum load to failure, maximum load/graft width, and stiffness are significantly lower for the allograft freeze-dried fascia lata group compared with the autologous, solvent-dehydrated, and dermal graft groups'''
* '''Xenograft PVS'''
** The forms of xenograft used are porcine dermis, porcine small intestinal submucosa, and bovine pericardium
** '''Less tensile strength''' than allograft in situ and '''highest propensity to encapsulate'''
* '''Synthetic PVS'''
** '''The most commonly used synthetic material for PVSs is polypropylene mesh.'''
** '''Advantages:'''
*** '''Almost unlimited supply''' of artificial graft material in various sizes and shapes, consistency in quality, '''elimination of harvest site complications''', and decreased operative time.
*** More uniform, consistent, and durable compared with biologic grafts
*** Sterile, biocompatible, and noncarcinogenic
*** '''Lowest amount of degradation or disruption and the highest amount of fibroblast ingrowth and tissue ingrowth into the specimen'''
** '''Disadvantages'''
*** '''Significant inflammatory and foreign body reactions'''
*** '''Higher rates of graft infection, urinary tract perforation, and vaginal exposure'''
**** '''No longer used to due risk of complications'''
'''Patient counselling'''
*If a synthetic prosthetic or biologic graft material is being used, surgeons should thoroughly counsel their patients about the permanent nature of these products and the unique and sometimes serious complications related to their use.
*'''Risk of''' '''transient and permanent voiding dysfunction after surgery, including''' '''postoperative difficulty emptying the bladder and de novo urgency and frequency'''