Autologous Transobturator Fascia Lata Sling for Female Stress Urinary Incontinence: A Pilot Feasibility and Safety Study

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Abstract
Objective: To evaluate the preliminary safety, feasibility, and short‐term outcomes of the autologous transobturator fascia lata sling for female SUI to our knowledge the first series using fascia lata via a transobturator route, in view of the mesh‐related complications of synthetic midurethral slings and the limitations of rectus fascia harvest in women with prior abdominal surgery, central obesity, or scarred fascia. Methods: Prospective single‐arm pilot feasibility and safety study of 40 women with SUI or stress‐predominant mixed urinary incontinence (MUI) who underwent autologous transobturator fascia lata sling at Al‐Azhar University Hospitals (June 2023 to May 2025; NCT05646745). Outcomes were assessed at 24 h, 2 weeks, and 3 months using the cough stress test, ICIQ‐FLUTS questionnaire, and VAS pain scores. Results: Mean age was 48.9 ± 7.8 years; BMI 31.4 ± 4.1 kg/m 2 . At 3 months, the overall success rate (cured + improved) was 87.5%, and the objective cure rate (negative cough stress test) was 72.5%. ICIQ‐FLUTS incontinence score decreased from 12.75 ± 3.41 to 3.23 ± 2.91 ( p < 0.001, Cohen's d = 2.79); incontinence QOL from 35.88 ± 5.83 to 4.50 ± 7.22 ( p < 0.001, d = 5.38). No voiding dysfunction, sling erosion, or major complications occurred. Grade I incontinence achieved 100% success. Thigh and groin pain resolved by 3 months in 92.5% and 100%, respectively. Conclusion: This preliminary exploratory study suggests that autologous transobturator fascia lata sling is a feasible and promising mesh‐free technique for female SUI with favorable short‐term outcomes at 3 months. These results must be interpreted cautiously given the small sample size, short follow‐up, and absence of a control group. Longer follow‐up, multicenter validation, and randomized comparative studies are warranted. Trial Registration: ClinicalTrials.gov : NCT05646745

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