Stress urinary incontinence (SUI) is the most common type of urinary incontinence in women. When conservative measures fail, surgery is indicated. For women who don’ t want to have the vaginal mesh, autologous mid- urethral fascial slings (AFS) offered as a primary surgery in many countries. Nevertheless, the clinical data on the efficacy and safety of  AFS is sparse and contemporary series are limitted. Here we present a retrospective series of women undergoing a mid- urethral AFS surgery for the treatment of SUI.

Women undergoing mid-urethral AFS for SUI at a tertiary referral center between February 2021 and March 2025 were retrospectively reviewed. All patients had received pelvic floor muscle training for at least 6 weeks and/or medical treatment prior to surgery. Informed discussions were held regarding available surgical options, including synthetic slings, Burch colposuspension, and urethral bulking agents. Women who chose AFS were included.

Autologous fascia was harvested and placed at the mid-urethra via the retropubic route using a standardized surgical technique. Data on demographics, surgical details, postoperative outcomes, and complications were collected.

Sixty patients were included, with a median age of 54 years (range: 39–77) and a median follow-up of 16 months (range: 1–49). AFS was the primary procedure in 57 patients (89.4%). Complete dryness was achieved in 47 patients (78.3%). Patient Global Impression (PGI) of improvement at 6 weeks averaged 77.0% (±27.1). The median hospital stay was 2 days.

The overall complication rate was 20% (12/60). Complications included mechanical sling failure (3.3%), temporary intermittent self-catheterization (8.3%), wound complications at the harvest site (8.3%), sling release (3.3%), and de novo urgency requiring botulinum toxin injection (3.3%).

This study demonstrates that autologous mid-urethral fascial sling (AFS) surgery is an effective and acceptable treatment option for women with stress urinary incontinence who prefer to avoid synthetic mesh. A high rate of complete continence (78.3%) and substantial patient-reported improvement support the efficacy of the procedure. While the complication rate was moderate (20%), most adverse events were manageable and did not lead to long-term morbidity. Temporary voiding dysfunction and wound complications were the most common issues, underscoring the importance of appropriate patient counseling and careful surgical technique. The low rates of sling release and mechanical failure indicate good technical durability.

Mid-urethral AFS is a viable alternative to synthetic slings in the surgical treatment of stress urinary incontinence, offering favorable continence outcomes and acceptable complication rates. This approach may be especially valuable for women who are concerned about mesh-related risks. Further prospective studies with larger cohorts and longer follow-up are needed to confirm long-term efficacy and safety.