Background:The current body of evidence is limited regarding the long-term outcomes of different modalities for stress urinary incontinence (SUI). We conducted this systematic review and network meta-analysis to compare the long-term follow-up outcomes of mid-urethral slings (MUS), Burch colpo-suspension, pubo-vaginal sling (PVS), anterior colporrhaphy with Kelly's plication, and laser therapy in the treatment of SUI. Aim of the work:The current work aimed to compare the long-term follow-up outcomes of the following modalities in the management of SUI: MUS, Burch colpo-suspension, PVS, SIMS, anterior colporrhaphy with Kelly's plication, bulking agents, and laser therapy. Methods:In this systematic review and network meta-analysis, we included prospective and retrospective studies that assessed the long-term outcomes of modalities for the management of SUI. We performed an online, bibliographic, search in four bibliographic databases: Cochrane Central Register of Controlled Trials (CENTRAL), Medline via PubMed, Web of Science, and Scopus.Results: A total of 42 studies were included. For the subjective cure rate, five different interventions were compared; pooling direct and indirect comparisons revealed an advantage of tension-free vaginal tape (TVT) intervention over TVT-obturator (TVT-O), laparoscopic Burch colpo-suspension, trans-obturator tape (TOT), and TVT-sling (TVT-S). Concerning objective cure rate, the pooling direct and indirect comparisons showed an obvious advantage of TOT, followed by TVT, and then TVT-O, Burch lap, and TVT-S. For repeated surgery, four different interventions were compared, and the comparisons revealed an advantage of TVT intervention over TVT-O, PVS, and TOT. The comparisons revealed the advantage of TVT and TVT-O over other procedures for lower urinary symptoms and postoperative complications.Conclusion: MUS appears to be the most effective and safe procedure for SUI at long-term follow-up. However, these findings should be interpreted with caution as there is scarcity in the published reports assessing long-term outcomes of other modalities, especially PVS and laser therapy.
Background: Epidural analgesic technique is the most commonly used and most effective analgesia during labor. Intrathecal labor analgesia is alternatively and effective method to provide labor analgesia. Aim of Study: To compare the effect of epidural bupivacaine versus single-dose intrathecal bupivacaine during labor of multiparous women on the duration of labor analgesia, progress of labor, block characteristics and side effects. Material and Methods: In a prospective randomized double-blind study, 80 multiparous women of ASA class I and II were randomly allocated into two groups of pregnant women 40 each. The spinal group received hyperbaric bupivacaine 0.5% at a dose of 3.75mg (0.75ml) of hyperbaric bupivacaine with 25ug fentanyl (0.5ml) and diluted with sterilized normal saline to 1.5ml whereas the epidural group received isobaric bupivacaine 8-10ml of 0.125% bupivacaine with fentanyl 50µ g. Patients were monitored for hemodynamics, sensory and motor block characteristics, side effects, duration of stages of labor and pain intensity was also recorded on a visual analogue scale. Results: Maternal hemodynamics showed a nonsignificant changes between both groups. Onset of sensory block and duration were significantly delayed in epidural group in comparison to spinal group (8.80±5.27, 163±16.64min) vs (4.6± 1.20, 120.2±3.33min) and visual analogue scale comparable in both groups but scale was lower in the spinal group. Patient's satisfaction was insignificantly more in S group. The duration of the first and second stages of labor in the spinal group was shorter than that in the epidural group and incidence of maternal complications in both groups were insignificant. Conclusion: A safe and effective alternative method to epidural analgesia is a single-dose intrathecal bupivacaine.
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