Autologous Semitendinosus Hamstring Tendon Transplant for Female Urinary Stress Incontinence Treatment (Anat-SUBLIM: Anatomy for Suburethral Ligamentoplasty): A Cadaver Model.

INTRODUCTION AND HYPOTHESIS: Autologous alternatives to non-absorbable synthetic slings are needed for the surgical treatment of women with stress urinary incontinence (SUI). Hamstring tendon (HT) autografts-gracilis (GT) and semitendinosus (STT)-are widely used in orthopedic ligament reconstruction. The use of STT as a mid-urethral sling (MUS) has been previously described. This cadaveric study was aimed at comparing the morphometric characteristics of GT and STT harvested through a minimally invasive anterior knee approach and to assess whether their length is sufficient for suburethral placement via vaginal and retropubic (bottom-to-top) approach.

METHODS: Four fresh-frozen, unembalmed female cadavers with intact pelvis and knees were included. Procedures were performed by two SUI surgeons and one orthopedic surgeon. Primary outcomes were bilateral measurements of GT and STT length and thickness. Secondary outcomes included comparison with the length of retropubic tension-free vaginal tape (TVT) slings and evaluation of the feasibility of STT placement via vaginal and retropubic routes.

RESULTS: The STT demonstrated greater length and thickness than GT (length: 130.8 ± 19.5 mm vs 104.8 ± 6.7 mm, p = 0.003; thickness: 3.3 ± 0.6 mm vs 1.6 ± 0.3 mm, p = 0.0001). The total length (all segments) was 285 ± 16.7 mm for STT and 269 ± 20.8 mm for GT. The mean length of the implanted retropubic TVT sling was 210 ± 1.04 mm. Tendon harvesting and STT placement was successfully performed.

CONCLUSION: The STT autograft placement as a retropubic MUS is feasible in a cadaveric model. STT length exceeds that of GT length and currently used synthetic slings, supporting its potential as an autologous alternative.