Overview
This is a multi-centre randomized controlled trial comparing mid-urethral synthetic mesh sling or tension-free vaginal tape (TVT) and autologous fascia sling (AFS) in elderly patients with stress predominant urinary incontinence. The investigators aim to investigate new onset pelvic pain 6 months post-op and objective urinary incontinence cure rate 5 years post-op. Secondary objectives include investigation of opioid use, mental health, sexual health, and other post-op outcomes.
Eligibility
Inclusion Criteria:
- Adult females at birth (female anatomy, any gender)
- Greater than or equal to 60 years old
- Have stress predominant urinary incontinence (spUI) eligible for both types of surgery (tension-free vaginal tape and autologous fascia sling)
- Exhausted conservative management options for UI (Kegel's exercises, physiotherapy, pessary)
- Completed childbearing
- Able to follow up with clinic visits for up to five years after surgery
Exclusion Criteria:
- Clinical Frailty Score of 6 or more, as moderate frailty is likely associated with excessive postoperative deterioration
- Concurrent pelvic surgery
- Neurogenic bladder
- Previous UI surgery
- Previous pelvic radiation
- Previous mesh exposure
- Presence of pelvic pain for more than three months in the last five years
- Likely unable to follow up
- Immunocompromised individuals receiving immunosuppressive medications for at least 3 months
- Chronic systemic steroid use for at least 3 months for autoimmune diseases
- Unable to stop smoking for at least 3 months prior to surgery and at high risk of restart smoking post-operatively