The fascia sling for isolated stress incontinence in prepubertal girls: Robotic approach stepwise demonstrated.

Abstract

<h4>Introduction</h4>Stress urinary incontinence (SUI) affects girls & women regardless of age, posing unique challenges in Adolescents and Young Adults (AYA) seeking fertility preservation and considering pregnancy. Autologous fascia slings remain the gold standard for isolated SUI, especially with a wide bladder neck, offering a natural hammock and reducing erosion and infection risk compared to synthetic mesh. This series illustrates the RA fascia sling technique.<h4>Material & methods</h4>A cases series of 5 female patients, mean age 12 years old (IQR 8,5-17) with lifelong SUI unresponsive to physiotherapy underwent video-urodynamics confirming SUI during Valsalva without detrusor overactivity and showing a wide bladder neck.<h4>Results</h4>All patients were positioned gynecologically docked with three 8-mm trocars. In 25-degree Trendelenburg, the retropubic space was dissected, exposing bladder and urethra. A tunnel was created caudally to the urethra, preserving the vaginal wall. Fascia harvested from rectus abdominis was passed through using a guide loop and secured to the pubic bone, creating a hammock for the bladder neck-urethra zone. Minimal blood loss (<5 mL) occurred; all patients were discharged on postoperative day one. Continence was maintained at one-year follow-up.<h4>Conclusions</h4>Robotic autologous slings offer a minimally invasive solution for SUI in AYA females considering pregnancy, with excellent short- and long-term outcomes and rapid recovery.