Autologous Fascial Pubovaginal Sling (PVS)
An autologous fascial sling uses the patient's own rectus sheath or fascia lata to support the urethra. It is an established surgical option for female stress urinary incontinence (SUI), including primary and selected recurrent cases. It avoids a synthetic sling mesh but adds a harvest wound and can cause obstruction, pain, infection or recurrent incontinence. Traditional bladder-neck PVS and modified midurethral fascial slings differ in position and fixation; their outcomes and operative details should be identified separately.[1][2]
For other options, see the female SUI database, synthetic slings and Burch colposuspension. The FDA's 2019 action concerned transvaginal mesh for prolapse and was not a ban on every SUI sling or abdominal sacrocolpopexy mesh.[3]
Selection and Counseling
| Situation | Decision points |
|---|---|
| Primary SUI or stress-predominant mixed incontinence | Autologous fascia PVS is one option alongside synthetic MUS, Burch and bulking. Discuss expected stress-leakage benefit, existing urgency, recovery, harvest morbidity and the possibility of catheterization. |
| Fixed or poorly mobile urethra | AUA/SUFU includes PVS, retropubic MUS, bulking and adjustable retropubic slings as options. Its discussion favors PVS for a non-mobile urethra. Urethral mobility and intrinsic sphincter deficiency are related assessments, not interchangeable diagnoses. |
| Recurrent SUI after prior surgery | Reassess the mechanism: recurrent stress leakage, obstruction, urgency, mesh complications and impaired emptying need different treatment. A salvage PVS is an option. |
| Concomitant urethral diverticulectomy, urethrovaginal fistula repair or urethral mesh excision | AUA/SUFU advises against a synthetic MUS during these repairs. If concurrent continence surgery is appropriate, autologous fascia is preferred over other biological sling substitutes. This is different from a remote, healed history of urethral surgery.[1] For bothersome SUI with a diverticulum, counsel on concurrent versus staged continence surgery: diverticulectomy alone may resolve SUI, while de novo retention has been reported particularly with concurrent PVS. EAU gives a concomitant nonsynthetic sling a Weak recommendation after counseling and notes no consensus on timing.[35] |
| Radiated, scarred or otherwise poorly healing tissue | Consider avoiding synthetic mesh. Autologous harvest and recipient-site healing still carry risks; timing and reconstruction should be individualized. |
AUA/SUFU's counseling of index patients on surgical options is a Strong Recommendation (Grade A); options for a fixed urethra and avoiding mesh in poorly healing tissue are Expert Opinion, while avoiding synthetic MUS during concurrent urethral diverticulectomy, urethrovaginal fistula repair or urethral mesh excision is a Clinical Principle.[1] Choice varies with urethral fixation, tissue healing and concurrent surgery.[1] After failed non-surgical management, NICE NG123 offers colposuspension (open or laparoscopic) or an autologous rectus fascial sling and includes a retropubic midurethral mesh sling in the same choice, subject to mesh-specific guidance; it advises against porcine dermis slings.[22]
Before surgery, document demonstrable stress leakage, symptom burden, pelvic examination, urinalysis and residual urine. Additional evaluation is appropriate for diagnostic uncertainty, substantial voiding dysfunction, recurrent surgery or other non-index features. Discuss what will happen if the patient cannot empty: temporary drainage, intermittent catheterization and possible sling revision.[1]
Graft Choice and Harvest
The rectus-fascia page covers abdominal anatomy, harvest planning and the cadaveric nerve-mapping study. The fascia-lata page covers thigh harvest and donor-site follow-up. A free graft has no retained vascular pedicle.
| Donor site | Practical considerations |
|---|---|
| Anterior rectus sheath | Convenient when the abdominal donor site is suitable. Inspect prior incisions, hernia repair, mesh and fascial quality. Miller et al. describe a 10-cm rectus-fascia graft with nonabsorbable stay sutures.[6] Asfour et al. describe an 8 × 1 cm graft harvested through a 6-cm low transverse incision with PDS stay sutures.[7] To protect the ilioinguinal and iliohypogastric nerves, a cadaveric mapping study placed the safest harvest 5.4 cm above the pubic symphysis, allowing a 9.4-cm inferior graft border (4.7 cm on each side of midline) in that 12-donor model; the safe length shortens nearer the symphysis.[21] Do not extend the incision beyond the lateral borders of the rectus. Preserve viable edges and close the donor defect. |
| Fascia lata | Useful when the abdominal fascia is unsuitable or another donor site is preferred. Direct exposure and fascial-stripper techniques (a short longitudinal lateral-thigh incision with a stripper advanced along the iliotibial band) are distinct approaches; the stripper technique has been reported with minimal donor morbidity.[9] Account for thigh anatomy, mobility, prior surgery and the required graft width/length; counsel about hematoma, sensory change, contour changes, pain and herniation. |
Hong's registry included 41,533 sling operations but only 160 rectus-fascia and 81 fascia-lata cases. Autologous fascia had higher adjusted odds of 30-day composite adverse events than synthetic mesh (aOR 3.63), and fascia lata higher than rectus (aOR 2.11); the fascia lata difference was not significant once UTI was excluded (aOR 1.93, 95% CI 0.81–4.63). The data lacked key information about previous continence surgery, retention and long-term outcomes. It is not a randomized donor-site comparison.[4]
In Buckley's 201-woman pelvic-floor harvest cohort, 64 women reported a thigh issue at six weeks. One postoperative thigh hematoma after sacrocolpopexy/hysteropexy harvest required transfusion and drainage, and two women underwent donor-site hernia repair. Graft sizes differed between sling and prolapse operations.[5]
Traditional Bladder-Neck PVS
McGuire and Lytton (1978) reported a pubovaginal autogenous fascial sling in 52 patients with stress incontinence and poor urethral sphincter function (urethral pressure below 10 cm H₂O), 42 of whom had undergone a previous incontinence operation. The result was satisfactory with good urinary control in 50 and a failure in 2. Uninhibited detrusor dysfunction present in 29 before surgery ceased in 20, and postoperative urethral pressure studies showed that the sling raised urethral pressure without obstructing voiding.[32]
The aim is support at the proximal urethra or bladder neck with an individualized balance between continence and emptying. A published rectus-fascia technique uses a roughly 10-cm graft and nonabsorbable stay sutures; other constructions use different dimensions and fixation. The stages below describe operative principles; suture and spacer choices vary by technique.[6][1]
- Plan and harvest the graft. Select the donor site, keep the graft moist in saline-soaked gauze, place nonabsorbable stay sutures (for example 0 polypropylene) at each end as handles for retropubic passage and fixation, and close the donor defect with running absorbable suture.
- Expose the proximal urethra. An inverted-U anterior vaginal incision is one described approach. Develop controlled paraurethral planes and identify the intended entry into the retropubic space; prior surgery or scarring can alter these planes.[25] The bladder-neck/proximal-urethral junction has been identified by gently tugging on the Foley balloon while palpating vaginally; some surgeons begin the vaginal exposure before graft harvest in cases where difficult vaginal access might force the case to be abandoned.[25]
- Pass the suspension sutures. Confirm bladder decompression before retropubic passage. Use the chosen carrier (Stamey needle, Pereyra ligature carrier or long clamp) by a guided top-down or bottom-up route. In Rowley et al.'s top-down Stamey technique, maintain needle contact with the guiding vaginal finger along the posterior pubis; then deliver the graft on its stay sutures according to the selected route and anatomy.[25] A described tactile method keeps a long curved clamp against the back of the pubis while a finger in the ipsilateral vaginal incision guides the tip through the endopelvic fascia beside the urethra; if the clamp is seen in the bladder on cystoscopy, it is withdrawn, repositioned and cystoscopy is repeated, and passage alone (without a full-thickness injury) does not require formal repair.[24] When the retropubic space is scarred by prior surgery or radiation and blind passage is impractical, an alternative is to open the suprapubic fascia and dissect bilaterally under direct vision down to the endopelvic fascia before passing the carrier, or, working from the vaginal side, to pass the carrier upward along the plane just posterior to the symphysis (or along a fibrous band bridging a pubic diastasis) until it exits the suprapubic incision; forcing a pathway through distorted post-traumatic or post-surgical anatomy is discouraged, and bimanual guidance with cystoscopy is used to confirm the carrier's position. These are described alternative routes for a hostile retropubic space.[25][26]
- Check lower-tract integrity. Perform intraoperative cystourethroscopy to identify bladder or urethral injury and intraluminal material, and confirm ureteral efflux. If a passage is revised, reassess integrity. Tailor repair and drainage to any injury's location and extent. A bladder or urethral injury from deep dissection has been managed with two-layer closure; for a transvaginal urethral injury, closing the urethra with the sling itself providing an additional layer has been described, with a Martius interposition flap considered if the defect is large or tissue quality is poor. Direct obturator-nerve injury during retropubic passage, or nerve compression from a retroperitoneal hematoma, can present as medial-thigh sensory symptoms and weak hip adduction; sling release within the first 24 postoperative hours has been suggested for significant neuropraxia without a major hematoma, with hematoma evacuation and physical therapy used as otherwise indicated.[24]
- Position and fix the sling. Support the intended urethral level without twisting the graft. Miller et al. describe securing the graft to periurethral tissue after retropubic passage in their rectus-fascia technique.[6] Tie the stay sutures over the rectus fascia without tension, leaving the sling loose for the intended support and emptying strategy. No particular instrument under the sling, Q-tip maneuver or visual cystoscopic appearance guarantees absence of postoperative obstruction. Described confirmation methods include tying the sutures loosely across the midline while a right-angle clamp is held between the sling and posterior urethra, or directly viewing the proximal urethra with a rigid cystoscope while gently pulling on the free sling ends to confirm the graft lies under the bladder neck; one illustrated technique instead uses a catheter in the urethra with scissors between the sling and urethra and two assistant fingers over the rectus sheath while the sutures are tied.[23][27]
- Close and plan drainage. Confirm hemostasis and document the graft source, dimensions, fixation, cystoscopic findings, any injury and the postoperative voiding or drainage plan.[6][1]
Modified Midurethral Fascial Slings
“Sling on a string” describes a family of modifications, not one interchangeable recipe. Asfour's illustrated modified Aldridge technique uses a 6-cm skin incision to harvest approximately 1 × 8 cm of rectus sheath, with doubled 0 PDS suspension sutures and a midpoint marker. The graft is placed at the midurethra, with controlled bottom-to-top passage, cystoscopy and tension adjustment.[7]
Osman's retrospective series included 106 women, with mean follow-up of nine months. Subjective cure was 87.8% in primary SUI and 72.0% after previous surgery; intermittent catheterization beyond two weeks occurred in 2.0% and 10.5%, respectively.[8] Shaw's separate 19-woman midurethral series included four women with voiding dysfunction and three sling loosenings.[8][9]
Adjustment evidence: a 2025 randomized trial compared 3-cm and 6-cm suspension-knot heights above the aponeurosis for a retropubic rectus-fascial sling. Among 52 analyzed women, retention at two weeks occurred in 9/27 versus 5/25, and at four weeks in 4/27 versus 2/25.[10] Five women underwent sling division, relieving symptoms in four; one woman in each arm remained catheter dependent at 12 weeks. At 12-week follow-up, the trial was too imprecise to identify an optimal gap or establish equivalence.[10] It did not test a clamp placed beneath the urethra.[10] An earlier prospective cohort of 51 women found a strong association between a shorter lax sling height above the rectus fascia and prolonged retention: at a 40-mm cutoff, sensitivity and specificity for retentive complications were 100% and 51%, respectively; none of the women with a measured height above 40 mm had a retentive complication in this cohort, and a looser sling up to 60 mm was not associated with persistent SUI.[31] Overall, 19.6% (10/51) developed postoperative retention; half resolved with temporary self-catheterization and half needed ongoing catheterization or sling division.[31]
Transobturator and laparoscopic fascial modifications have separate, smaller evidence bases.[2]
Evidence for Continence and Durability
| Evidence | Finding that helps counseling | Interpretation |
|---|---|---|
| SISTEr RCT, 655 women | At 24 months, rectus-fascia PVS achieved 66% versus 49% SUI-specific success compared with Burch; strict overall success was 47% versus 38%. | Participants had urethral hypermobility; outcome assessment was available for 520 women. These are cumulative success estimates. Sling patients had more UTI, voiding difficulty and postoperative urgency incontinence.[11] |
| E-SISTEr extension, 482 enrolled | Five-year cumulative continence estimates were 30.8% sling versus 24.1% Burch; most respondents remained satisfied. | Observational follow-up preferentially enrolled women with persistent incontinence. The cumulative endpoint differs from both cross-sectional dryness and the original trial's definition.[12] |
| 2020 Cochrane synthesis, 34 trials/3,244 women | Traditional slings offered better medium-term continence than open colposuspension, with more voiding morbidity. Against MUS, 1–5-year continence was 67% versus 74%, OR 0.67 (95% CI 0.44–1.02). | Fully incorporated search ended February 2017. The six-trial medium-term MUS analysis included 458 women and heterogeneous traditional sling materials.[2] |
| 2024 and 2025 randomized-study syntheses | No clear cure difference between autologous and synthetic sling groups; autologous operations took longer. The 2024 synthesis reported more de novo urgency with autologous slings (RR 2.84, 95% CI 1.13–7.10).[13] | The 2025 review included three studies of primary surgery; studies, methods, outcome definitions and follow-up overlap.[13][14] |
| Khan randomized-cohort follow-up, 162/201 respondents | At median ten years, dry or improved was 75.4% after fascia versus 73% after TVT; completely dry was 50.8% versus 31.7%. | Selected long-term responders and a single trial.[15] |
| Nair standard-versus-short fascial-sling follow-up, 107/165 original participants | At median 17 years, symptom/QoL comparisons did not clearly differ; reported satisfaction was 67.2%.[16] | — |
Offiah's 2025 single-center survey analyzed 395 respondents, including only 34/90 invited fascia-sling patients. Reported SUI absence was similar for fascia and TVT, but procedure choice was not randomized, follow-up and technique varied, and mesh exposure was not assessed.[17]
Emptying, Urgency and Follow-up
- Voiding trial and drainage: assess postoperative emptying and arrange a specific catheterization plan if the patient cannot empty safely. Persistent difficulty warrants review for obstruction and other causes, with discussion of the continence consequences of sling loosening, incision or revision.[1] The 2024 CUA female SUI guideline recommends catheterization for 1–2 days followed by a repeat voiding trial; for persistent retention, it recommends sling loosening within one week or incision at 4–6 weeks when possible .[33] Historical sling-incision series describe relief of persistent obstruction after pubovaginal slings. Nitti et al. reported successful midline lysis in 84% of 19 women with mixed sling materials and recurrent SUI in 17% at mean 12-month follow-up; Thiel et al. reported no catheter dependence among 11 long-term respondents after fascia-lata sling incision at mean 60.8-month follow-up.[29][30]
- Urgency and mixed incontinence: stress leakage may improve while urgency persists or develops. Bothersome new symptoms, infection and impaired emptying are evaluated. A urodynamic detrusor-overactivity endpoint is not interchangeable with patient-reported urgency.[1][2]
- Donor and recipient wounds: monitor pain, hematoma, infection, dehiscence and hernia; examine persistent vaginal symptoms or concern for urinary-tract injury.[1][4][5]
- Long-term assessment: arrange an in-person review within six months that includes symptoms, incision examination and postvoid residual measurement (AUA/SUFU Expert Opinion; NICE NG123 also advises follow-up within six months).[1][22]
Preoperative residual urine and flow help identify patients needing more evaluation and catheterization counseling. In a 29-woman autologous rectus-fascia PVS series, preoperative PVR >100 mL was associated with prolonged intermittent catheterization (P <0.05); Qmax ≤20 mL/s showed a nonsignificant comparison (P = 0.09).[34]
Salvage and the Severely Compromised Outlet
Autologous PVS can be offered for selected persistent or recurrent SUI after a synthetic sling or mesh complication, with realistic expectations:
| Series | Observed outcome | Limitation |
|---|---|---|
| Milose, 66 women after at least one failed MUS | 46/66 reported SUI cure at mean 14.5 months; only 25/66 had neither stress nor urgency incontinence. | Retrospective; most had mixed incontinence.[18] |
| Chen, 18 women after at least two failed MUS | 16/18 were cured or improved at median 80 months. | All also had partial sling excision and urethrolysis.[19] |
| McCoy, 46 women with mesh sling complications: concomitant mesh incision with or without partial excision, or staged PVS | 42/46 objective and 35/46 subjective success at mean 16 months; 22% required subsequent interventions. | Staged/concomitant groups were not randomized.[20] |
For severe outlet dysfunction or recurrent or persistent SUI, AUA/SUFU permits consideration of an obstructing autologous PVS or bladder-neck closure with drainage after counseling. These require an explicit plan for bladder storage safety, upper-tract protection and catheterization. The guideline discussion advises against tensioning a synthetic sling to create this obstructing effect.[1]
For a very wide-open proximal urethra with complete loss of proximal sphincter function, crossing the sling ends in front of the urethra in the retropubic space (rather than the conventional posterior-vector construction) has been described to increase sling contact and coaptation, with the crossed vector reported to achieve closure at lower pressures than a posterior-vector sling; the degree of compression needed may make normal voiding or intermittent catheterization difficult, and autologous fascia has been favored over synthetic mesh when ongoing catheterization is anticipated.[26][28] This is author-described technique and opinion for a rare severe-outlet phenotype, without a comparative cohort or measured pressure difference.[26][28]
See bladder-neck closure and bladder-neck reconstruction for the distinct outlet-closure and diversion decisions.
Videos
References
1. American Urological Association/SUFU. Surgical Treatment of Female Stress Urinary Incontinence. 2023 amendment. Evaluation, counseling, autologous fascia PVS, Statements 12, 16–18 and 22, and follow-up. Full guideline.
2. Saraswat L, Rehman H, Omar MI, et al. Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database Syst Rev. 2020;1:CD001754. doi:10.1002/14651858.CD001754.pub5. Full text.
3. US Food and Drug Administration. Pelvic Organ Prolapse (POP): Surgical Mesh Considerations and Recommendations. Regulatory overview.
4. Hong CX, Son Y, Patel VJ, Lince K, Gupta P. Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a national surgical registry. Neurourol Urodyn. 2024;43(4):925-934. doi:10.1002/nau.25434.
5. Buckley VA, Vereeck S, Karjalainen PK, Rosamilia A. Morbidity Associated With Autologous Fascia Lata Harvesting for Pelvic Floor Surgery. International Urogynecology Journal. 2026;37(4):1049-1054. doi:10.1007/s00192-025-06421-6
6. Miller AR, Linder BJ, Lightner DJ. Autologous Rectus Fascia Sling Placement in the Management of Female Stress Urinary Incontinence. International Urogynecology Journal. 2018;29(9):1403-1405. doi:10.1007/s00192-018-3643-1
7. Asfour V, Nikolopoulos KI, Digesu GA, Emery S, Khan Z. Modified autologous fascial sling technique ('sling on a string') for stress incontinence. Int Urogynecol J. 2022;33(2):435-438. doi:10.1007/s00192-021-04815-w.
8. Osman NI, Hillary CJ, Mangera A, et al. The Midurethral Fascial "Sling on a String": An Alternative to Midurethral Synthetic Tapes in the Era of Mesh Complications. European Urology. 2018;74(2):191-196. doi:10.1016/j.eururo.2018.04.031
9. Shaw JS, Gerjevic KA, Pollack C, Strohbehn K. Minimally Invasive Autologous Fascia Sling at the Midurethra: A Case Series. Journal of Minimally Invasive Gynecology. 2022;29(10):1165-1169. doi:10.1016/j.jmig.2022.07.001
10. Bortolini T, de Oliveira RT, Borges AG, et al. Urinary retention after autologous fascial sling placement: a randomised trial comparing adjustment techniques. BJU Int. 2025;136:271–279. doi:10.1111/bju.16755.
11. Albo ME, Richter HE, Brubaker L, et al. Burch Colposuspension versus Fascial Sling to Reduce Urinary Stress Incontinence. N Engl J Med. 2007;356:2143–2155. doi:10.1056/NEJMoa070416.
12. Brubaker L, Richter HE, Norton PA, et al. Five Year Continence Rates, Satisfaction and Adverse Events of Burch Urethropexy and Fascial Sling Surgery for Urinary Incontinence. J Urol. 2012;187:1324–1330. doi:10.1016/j.juro.2011.11.087. Full text.
13. Grigoryan B, Kasyan G, Pushkar D. Autologous Slings in Female Stress Urinary Incontinence Treatment: Systematic Review and Meta-Analysis of Randomized Controlled Trials. International Urogynecology Journal. 2024;35(4):759-773. doi:10.1007/s00192-024-05768-6
14. Mangir N, Güler H, Keskin H. Comparison of Surgical Outcomes of Autologous Mid-Urethral Fascia Slings and Retropubic Mid-Urethral Slings for Women Undergoing a Primary Surgery for Stress Urinary Incontinence: A Systematic Review and Meta-Analysis. Neurourol Urodyn. 2025;44:136–142. doi:10.1002/nau.25593.
15. Khan ZA, Nambiar A, Morley R, et al. Long-Term Follow-Up of a Multicentre Randomised Controlled Trial Comparing Tension-Free Vaginal Tape, Xenograft and Autologous Fascial Slings for the Treatment of Stress Urinary Incontinence in Women. BJU International. 2015;115(6):968-977. doi:10.1111/bju.12851
16. Nair DB, Khan Z, Mishra T, et al. Autologous fascial slings for stress urinary incontinence: a 17-year follow-up of a randomised controlled study. Int Urogynecol J. 2024;35(3):649-659. doi:10.1007/s00192-023-05702-2.
17. Offiah I, Carolina Ochoa D, Alvarado JM, et al. A medium to long-term study comparing stress urinary incontinence procedures. Neurourol Urodyn. 2025. doi:10.1002/nau.70101.
18. Milose JC, Sharp KM, He C, et al. Success of autologous pubovaginal sling after failed synthetic mid urethral sling. J Urol. 2015;193:916–920. doi:10.1016/j.juro.2014.09.038.
19. Chen J, Li B, Peng L, Shen H, Luo D. Autologous pubovaginal sling for recurrent stress urinary incontinence after two or more failed synthetic midurethral sling. Eur J Obstet Gynecol Reprod Biol. 2022;272:213-216. doi:10.1016/j.ejogrb.2022.03.024.
20. McCoy O, Vaughan T, Nickles SW, et al. Outcomes of autologous fascia pubovaginal sling for patients with transvaginal mesh related complications requiring mesh removal. J Urol. 2016;196(2):484-489. doi:10.1016/j.juro.2016.02.2976.
21. Cardenas-Trowers OO, Bergden JS, Gaskins JT, et al. Development of a safety zone for rectus abdominis fascia graft harvest based on dissections of the ilioinguinal and iliohypogastric nerves. Am J Obstet Gynecol. 2020;222(5):480.e1-480.e7. doi:10.1016/j.ajog.2019.12.009
22. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NG123. Published April 2019; last updated June 2019. Recommendations 1.5.2, 1.5.14 and 1.5.15. Recommendations
23. Karram MM. Pubovaginal Slings for the Correction of Stress Incontinence. In: Baggish MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 5th ed. Elsevier; 2021:763-778.
24. Barboglio Romo PG, Clemens JQ. Autologous Fascial Slings. In: Goldman HB, ed. Complications of Female Incontinence and Pelvic Reconstructive Surgery. 2nd ed. Springer (Humana Press); 2017:155-164. doi:10.1007/978-3-319-49855-3_15
25. Rowley KJ, Tibon J, Kraus SR. Autologous Pubovaginal Sling. In: Smith JA Jr, Dmochowski RR, Thomas JC, Preminger GM, eds. Hinman's Atlas of Urologic Surgery. 5th ed. Elsevier; 2025:762-770.
26. McGuire EJ, Margulies RU. Slings for Female Stress Urinary Incontinence. In: Montague DK, Gill IS, Angermeier KW, Ross JH, eds. Textbook of Reconstructive Urologic Surgery. Informa Healthcare; 2008:579-588.
27. Reeves F, Greenwell T. Sling Operations for Stress Urinary Incontinence and Their Historical Evolution. In: Martins FE, Holm HV, Sandhu JS, McCammon KA, eds. Female Genitourinary and Pelvic Floor Reconstruction. Springer; 2023:371-394. doi:10.1007/978-3-031-19598-3_22
28. McGuire EJ. Urethral Reconstruction in Women. In: Schreiter F, Jordan GH, eds. Urethral Reconstructive Surgery. Springer; 2006:43-58. doi:10.1007/3-540-29385-x_7
29. Nitti VW, Carlson KV, Blaivas JG, Dmochowski RR. Early results of pubovaginal sling lysis by midline sling incision. Urology. 2002;59(1):47-51. doi:10.1016/s0090-4295(01)01559-x
30. Thiel DD, Pettit PD, McClellan WT, et al. Long-term urinary continence rates after simple sling incision for relief of urinary retention following fascia lata pubovaginal slings. J Urol. 2005;174(5):1878-1881. doi:10.1097/01.ju.0000177493.41432.77
31. Preece PD, Chan G, O'Connell HE, Gani J. Optimising the tension of an autologous fascia pubovaginal sling to minimize retentive complications. Neurourol Urodyn. 2019;38(5):1409-1416. doi:10.1002/nau.24000
32. McGuire EJ, Lytton B. "Pubovaginal sling procedure for stress incontinence." J Urol. 1978;119(1):82-84. doi:10.1016/s0022-5347(17)57390-5
33. Carlson K, Andrews M, Bascom A, et al. "2024 Canadian Urological Association guideline: Female stress urinary incontinence." Can Urol Assoc J. 2024;18(4):83-102. doi:10.5489/cuaj.8751.
34. Mitsui T, Tanaka H, Moriya K, Kakizaki H, Nonomura K. "Clinical and urodynamic outcomes of pubovaginal sling procedure with autologous rectus fascia for stress urinary incontinence." Int J Urol. 2007;14(12):1076-1079. doi:10.1111/j.1442-2042.2007.01909.x
35. European Association of Urology. EAU Guidelines on Non-neurogenic Female LUTS. 2026. Sections 4.9.4.b–c and 4.9.5. Full guideline.