Adjustable Autologous Pubovaginal Sling for Complex Stress Urinary Incontinence: A Technical Surgical Video with a Case Series

Abstract Introduction and Hypothesis Autologous pubovaginal slings are an important option for the management of stress urinary incontinence (SUI) but are associated with higher risks of voiding dysfunction. There is no standardized method for tensioning that balances the effectiveness of treatment with the prevention of voiding dysfunction. Methods We present a video demonstrating the surgical steps of a novel combination of a fascia lata sling combined with an adjustable tensioning system, as well as an accompanying case series of short-term outcomes. The video demonstrates the use of this system for a 59-year-old female with chronic pain and tobacco use who presented with severe, recurrent SUI after Burch colposuspension. Results In 2025, a total of 9 cases of fascial slings combined with the adjustable tensioning system were performed at this institution, with all patients demonstrating a negative cough stress test after tensioning and with no cases of postoperative urinary retention or voiding dysfunction at least 6 months postoperatively. Data collection for long-term outcomes is ongoing. Conclusion The combination of an autologous fascial sling with a personalized adjustable tensioning system offers a unique modification to a commercially available system that may provide women with complex SUI and risk factors for mesh complications with a feasible way of achieving continence while mitigating the risks of voiding dysfunction typically seen with a fascial sling.