In this video, we present autologous fascial sling placement in patients with incontinence after radical cystectomy and orthotopic ileal neobladder surgery.

Fifty-seven years old female patient who had diagnosed with invasive bladder cancer three years ago had undergone radical cystectomy and orthotopic urinary diversion. The patient is on clean intermittent catheterization (CIC) 4x1 per day. In her physical examination stress, urinary incontinence is confirmed with a cough-stress test. She uses diapers four times per day. An autologous fascial sling operation was planned and informed consent had been taken from the patient. The patient was scrubbed and draped under spinal anesthesia in the lithotomy position. Suprapubic transversal 7 cm skin incision, 2 cm above symphysis pubis was made. After exposure of anterior rectus fascia, 10x1.5 cm fascial tissue as a greft was removed then fascia was closed with 0 polyglactin suture. 0 polypropylene sutures were placed and tied on both tips of sling material. 18 Fr foley catheter was placed into the neobladder. 10 cc saline was injected underneath the urethra for hydro dissection. On the anterior vaginal wall, a 2 cm midline incision was made. Bilateral blunt dissection was performed through the ipsilateral shoulder underneath the bladder neck with Metzenbaum scissors.  Needles were passed from the lateral sides of the bladder neck to the suprapubic region just behind the pubic bone via finger assistance. Cystoscopy was performed afterward, and no perforation or needle was seen in the neobladder. Prolen sutures were passed from down to up bilaterally via the assistance of silk sutures that had attached to the trocars before. The fascial sling was placed underneath the bladder neck. In the suprapubic area, bilateral polypropylene sutures are tied moderately on the midline in order to compress the sling. The vaginal wall was closed with 2-0 absorbable sutures.  Subcutaneous tissue and skin were closed. The Foley catheter was removed on the first postoperative day.  Skin sutures were removed on the postoperative 10th day.

Four weeks later the patient had no incontinence during the cough-stress test. The patient no longer uses diapers and continues to do CIC 4x1 per day. No complication was seen in the follow-up period.

In this video, we presented the autologous fascial sling placement after radical cystectomy and orthotopic ileal neobladder surgery. Constructive moderate tightly autologous fascial sling placement is effective and safe in patients with an orthotopic neobladder.