A 4 years old female and 1.5 months old male with classical exstrophy and a 2 days old male child with cloacal exstrophy were admitted in Paediatric Surgery Department of Sher-e-Bangla Medical College Hospital (SBMCH), Barisal. The mothers of all children had complaints of protrusion of fleshy mass in lower abdomen from birth. They always remain wet producing smell of urine.The cloacal exstrophy case had a prolapsed ileum that was discharging stool. He had no anus too.All of the cases underwent one stage closure of urinary bladder and urethra and lower abdomen without osteotomy and patient was discharged. After 8 months of first operation the female patient underwent repair of the wound dehiscence. At the time of discharge her urinary bladder capacity was 10 ml and remained dry for 5 minute after manual evacuation. The male patient with classical exstrophy developed urethrocutaneous fistula on 15 th post-operative day. The cloacal exstrophy case was discharged with end ileostomy on 10th post-operative day.

Autologous tissue has been used for pubovaginal sling construction for over a century. Compared with synthetic materials, fascial harvest carries additional and expected morbidity. However, by the nature of its definition, the use of autologous tissues is not associated with a significant immunogenic or any foreign body response. Randomized controlled trials have demonstrated and confirmed the durability of these procedures when compared with both colposuspensions and synthetic midurethral sling procedures. In light of the recent FDA warning regarding the use of synthetic materials for stress incontinence and pelvic organ prolapse surgery, the role of the autologous sling may be more prominent going forward. As such, the autologous pubovaginal sling remains a standard of care for the management of female stress urinary incontinence.   This review contains 6 figures and 30 references Key words: autologous rectus fascia, complications, outcomes, pubovaginal sling, randomized controlled trials, stress urinary incontinence

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