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

Objective: 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.

Patients And Methods: 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.

Results: 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.

Conclusion: There were no significant differences in urinary retention, continence rates, patient satisfaction, or complications between the two AFS adjustment techniques.