**4.1 Introduction**

306 Urinary Incontinence

or extrusion were noted. The authors also performed a biopsy for cases which required reoperation for correction of incontinence. They observed absence of the implanted graft on gross examination. Microscopically, only a few remnants of the SIS (< 0.4 mm) could be found **(Rutner et al, 2003)**. Farahat et al, reported also using SIS as TVT (figure 9) in the treatment of female SUI that the SIS sling was accepted nicely by the tissue after 12 months. No erosion, extrusion, or severe inflammatory reactions were noted. Most reactions were mild and usually observed as early as 10 days or as late as 45 days after the procedure. Most

reactions were well tolerated and resolved spontaneously **(Farahat et al, 2009).**

**Rutner et al, 2003** 152 SUI Pubovaginal slings +

**Patient group** 

**Jones et al, 2005b** 34 SUI TVT 80% **Farahat et al, 2009** 17 SUI TVT 82.3 %

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

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

**Technique of SIS graft placement** 

bone anchoring

**Treatment outcomes (% cured)** 

93.4%

**Author Number of** 

Table 7. Treatment outcome of SIS graft.

Fig. 9. SIS as TVT sling **(Farahat et al, 2009).**

**3.2.5 SIS graft complications**

in 2 patients.

**patients** 

Stem cells therapy for the regenerative repair of the deficient rhabdosphincter has been the most recent advance in incontinence research. The ultimate goal has been to achieve a permanent cure for SUI by restoration of the intrinsic and extrinsic urethral sphincter and the surrounding connective tissue, including peripheral nerves and blood vessels. Overall, the aim of stem cell therapy is to replace, repair, or enhance the biological function of damaged tissue or organs.
