**3.2.5 SIS graft complications**

However, unlike most reports confirming the safe use of the SIS graft in the treatment of SUI, Ho et al **(Ho et al, 2004)** reported inflammatory reactions (figure 10) at the abdominal incision (but none at the vaginal incision) in 6 out of 10 patients treated with the 8-ply SIS sling. Most cases resolved with minimal or no intervention. Abscess formation was observed in 2 patients.

John et al **(John et al, 2008)** used both the Cook 4-ply and the 8-ply Stratasis- TF in 16 women with SUI. They reported intense inflammatory complications in 5 patients (nearly one third). Most of the inflammatory reactions were related to the suprapubic region rather than near the vagina or urethra. Four of the 5 patients with complications had the new 8-ply Stratasis-TF. The remaining patient had the 4-ply SIS; however, this patient had a concomitant extensive pelvic floor reconstruction by a gynecologist prior to placement of the SIS sling. Apparently adding more layers to the SIS graft material may have a contributing role in inflammatory reactions, because these high complication rates were not observed with the older 1-ply and 4-ply formulations **(John et al, 2008; Santucci and Barber, 2005)**. No study till now compared the 1-ply, 4-ply, and 8-ply SIS grafts in humans.

Fig. 10. CT shows inflammation of subcutaneous tissue (*A*) and along arms of the SIS sling **(Ho et al, 2004).** 

The SIS graft material is well accepted by the host tissue, and considered safe and effective with lower incidence of erosion and infection than the synthetic midurethral slings. However, Long period of follow up are still required to support the durability of these preliminary results.
