SUI is the commonest form (8.3%) of urinary incontinence in female aged 15-49 years in Bangladesh. Sling surgeries are recommended for moderate to severe SUI. In developing countries like Bangladesh, where the cost of synthetic sling is much higher, autologous sling is a beneficial alternative. Previously ARFS was used for only complicated SUI but now it is widely admired & used for pure & mixed SUI patients. Reduced accessibility and availability of synthetic sling made us to start doing autologous fascia sling from 2018, at first in transobturator ways then in retropubic ways. In this study a comparison was made between the outcome of autologous rectus fascia sling in retropubic and transobturator ways retrospectively from 2018-2023.

Patients who underwent autologous fascia sling surgery from July 2018- July 2023 in popular medical college hospital were included in this study. Pre-operative data (Age, BMI, No of pregnancy, pelvic surgical history and type of incontinence), post-operative complications, subjective and objective cure were noted. Patients were followed upto 18 months post-operatively. Pre and post-operative ICIQ-FLUTS total score and total QoL scores were compared. Subjective cure rate was defined by PGI-I score ≤2. Objective cure rate was defined by negative cough stress test. Patients resuming symptoms of SUI are defined as a failed case.

Total 35 patients underwent autologous rectus fascia sling from July 2018-July 2023. Among them 24 patients (pure SUI-19, mixed SUI -5) were gone through retro-pubic sling and 11 (pure SUI- 8, mixed SUI -3) patients underwent transobturator sling. One patient from retropubic group and two patients from transobturator group were lost from follow up. Finally, 23 patients from retropubic group and 9 patients from transobturator group were continued to be included in the study. According to the pre-operative parameters, both groups were quite similar. Operating time (95±7.1 min) & VAS scoring (2.7±1.4) were insignificantly higher in retropubic group. Two patients from retropubic group developed bladder outlet obstruction (Clavein Gr-IIIA) which was taken care by prolonged catheterization and medication though didn’t need any surgical intervention. In both groups PGI-I score was ≤2. Cough stress test was noted 100% negative in both groups & no history of reoperations. All the patient showed significant improvement ICIQ-FLUTS questionnaire ICIQ total QoL score post-operatively.

Transobuturator group showed superiority in terms of voiding function than retropubic group after having autologous fascia sling.