Allograft Pubovaginal Slings: a Systematic Review

Purpose of Review: Stress urinary incontinence (SUI) in women is the most common form of urinary incontinence and can be treated with different surgical procedures. As a sling procedure, the materials used are synthetic in midurethral sling (MUS) and non-synthetic tissue in pubovaginal sling (PVS): autografts (autologous), allografts, and xenografts. Cadaveric fascia (CAF) has been offered as an autograft substitute for years despite higher costs and unknown long-term outcomes. Herein, we review the use of allograft PVS in terms of overall efficacy to date. A literature search was performed with PRISMA through PubMed and Cochrane databases to identify studies published before September 2021. Key terms included “pubovaginal sling,” “allograft,” and “incontinence.” Systematic reviews, meta-analyses, and articles where sample patient populations were not diagnosed with SUI or did not receive allograft PVS were excluded. Recent Findings: Twenty-two publications were found: eight were excluded, and fourteen met the criteria for review. Several publications compared the efficacy of CAF to autograft. Postoperative SEAPI scores displayed improved symptoms from baseline and success rates were equal to autografts. Two studies demonstrated a shorter lifespan of CAF. The origin of allograft material was considered. Other publications demonstrated that CAF had shorter operation times and post-operative hospital stays and lower infection rates. Summary: Allograft PVS has shown to be an efficacious option based on quantitative patient satisfaction scores. APVS provides less morbidity including shorter operation time, postoperative hospital stays, and low infection rates; however, there are a limited number of studies comparing allograft PVS to other PVS materials.