Systematic review and meta-analysis of “inside-out” versus “outside-in” transobturator tapes in management of stress urinary incontinence in women

Madhuvrata, Priya; Riad, Mohamed; Ammembal, Manjunath Kamath; Agur, Wael; Abdel‐Fattah, Mohamed

doi:10.1016/j.ejogrb.2012.01.004

Cited by 27 publications

(23 citation statements)

References 27 publications

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“…No differences were seen both in subjective cure rate and composite cure rates. This is in accordance with meta-analyses evaluating studies with shorter follow-up [4,9], indicating that different transobturator tapes may yield similar results and that these results are maintained in the medium-term. There was no difference between objective and subjective cure rates of TO-MUS in non-RCT studies.…”

Section: Discussionsupporting

confidence: 75%

“…As reported by others [9], TVT-O was associated with a significantly lower incidence of vaginal injuries than TOT, but other complications did not differ between the two approaches. There was a trend toward lower vaginal extrusion with TVT-O (OR 0.37), not reaching statistical significance.…”

Section: Discussionsupporting

confidence: 58%

“…A number of meta-analyses evaluating MUS have shown both their superiority in comparison with other techniques (colposuspension, autologous fascia slings, single-incision slings) and their efficacy and safety in different patient populations [1,[3][4][5][6][7][8][9][10][11]. All these meta-analyses included mainly short-term studies with only a few medium-term studies, and no long-term studies.…”

Section: Introductionmentioning

confidence: 99%

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Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis

et al. 2015

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Section: Discussionsupporting

confidence: 75%

Section: Discussionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

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Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis

et al. 2015

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“…We pooled the outcomes for the different anti-incontinence procedures, because they are equally effective in the treatment of SUI. 9,28,29 We also pooled different methods of prolapse repair, because surgical techniques will differ much between studies and surgeons anyway. We assumed that adverse events and bladder emptying would be related more to surgical procedure than to preoperative incontinence status.…”

Section: Data Extractionmentioning

confidence: 99%

Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta‐analysis of randomised trials

Ploeg

Steen

Rengerink

et al. 2014

BJOG

108

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Objectives The combination of prolapse surgery with an incontinence procedure can reduce the incidence of stress urinary incontinence (SUI) after surgery, but may increase adverse events. We compared the effectiveness and safety of prolapse surgery versus combined prolapse and incontinence surgery in women with pelvic organ prolapse.Design and setting Pubmed, EMBASE, DARE, the Cochrane Library and the register of Current Controlled Trials were searched for randomised trials (restricted to Burch colposuspension and midurethral sling as incontinence procedure) from 1995 to 2013 limited to the English literature.Methods Two reviewers selected eligible articles and extracted the data. Pooling for SUI was based on three patient groups: (1) women with coexisting SUI; (2) women asymptomatic for SUI; and (3) women with occult SUI. For adverse events, pooling was based on incontinence procedure.Main outcome measures The primary outcome was SUI. The secondary outcomes were treatment for SUI, bladder storage symptoms, obstructive voiding and adverse events.Results Seven trials were included. Pooling for women with coexisting SUI was possible for objective SUI with two studies and showed no difference. Statistical (I 2 = 95%) and clinical heterogeneity was, however, high. The largest study showed a lower incidence of persisting SUI (5% versus 23%) and treatment for this (0% versus 57%) in women who underwent prolapse repair with a midurethral sling. The second study did not find a difference in women undergoing a sacrocolpopexy with or without Burch colposuspension. In asymptomatic women, combination surgery resulted in a lower incidence of de novo subjective SUI (two studies; 24% versus 41%; relative risk [RR], 0.6; 95% confidence interval [CI], 0.3-0.9; I 2 = 36%) and the need for subsequent anti-incontinence surgery (three studies; 2% versus 7%; RR, 0.4; 95% CI, 0.2-0.8; I 2 = 13%). For the outcome objective SUI, pooling was possible for five studies, but statistical heterogeneity was high (I 2 = 82%) and the difference was not statistically significant. In the subgroup of women with occult stress incontinence, we found a lower incidence of objective SUI after combination surgery (two studies; 22% versus 52%; RR, 0.4; 95% CI, 0.3-0.8; I 2 = 32%). There were no differences in bladder storage symptoms, urgency incontinence or long-term obstructive voiding symptoms. Adverse events (two studies; 15% versus 10%; RR, 1.6; 95% CI, 1.0-2.5; I 2 = 0%) and prolonged catheterisation (three studies; 6% versus 1%; RR, 4.5; 95% CI, 1.5-13.3; I 2 = 0%)were more frequent after vaginal prolapse repair with a midurethral sling.Conclusions Combination surgery reduces the risk of postoperative stress incontinence, but short-term voiding difficulties and adverse events were more frequent after combination surgery with a midurethral sling.Keywords Burch colposuspension, meta-analysis, midurethral sling, pelvic organ prolapse, review, stress urinary incontinence.Please cite this paper as: van der Ploeg JM, van der Steen A, Oude Rengerink K, va...

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“…Comparisons of these two approaches have been limited to surgical safety and short‐ to medium‐term outcome. Long‐term outcome is still lacking …”

Section: Introductionmentioning

confidence: 99%

Inside‐out versus outside‐in transobturator tension‐free vaginal tape: A 5‐year prospective comparative study

et al. 2013

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Abbreviations & Acronyms BMI = body mass index DO = detrusor overactivity MUFR = maximum urine flow rate OAB = overactive bladder Pdetmax filling = maximum detrusor pressure at filling RCT = randomized clinical trials SD = standard deviation SI = stress urinary incontinence TOT = outside-in approach TO-TVT = transobturator tension-free vaginal tape TVT = tension-free vaginal tape TVT-O = inside-out approach USI = urinary stress incontinence Objective: To compare the 1-year and 5-year outcomes of transobturator tension-free vaginal tape with outside-in and inside-out approaches in women with urinary stress incontinence, and to identify risk factors for treatment failure at 5 years. Method: A prospective observational study was carried out for women with urinary stress incontinence who underwent transobturator tension-free vaginal tape from September 2004 to March 2008 in a tertiary urogynecology center. Women (n = 213) had either an outside-in (n = 124) or inside-out (n = 89) procedure. They were followed up annually until 5 years after the operation. Subjective cure was defined as women not experiencing any urine loss on physical activity. Objective cure was defined as no urine leak at cough during a standard urodynamic study. Results: At a mean follow up of 59.2 months, the subjective cure rates were 81.7% and 84.1%; the objective cure rate were 82.6% and 82.5% for the outside-in and inside-out approach, respectively. There was no statistically significant difference between the procedures. De novo overactive bladder syndrome (10.6% in outside-in and 14.6% in inside-out approach; P = 0.40) and de novo detrusor overactivity (5.8% in outside-in and 15% in insideout approach; P = 0.11) was also comparable between the two groups. Complications at the fifth year were low and not significantly different among both methods. Conclusion:The outside-in approach and inside-out approach are both safe and effective in treating women with urinary stress incontinence up to 5 years.

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Systematic review and meta-analysis of “inside-out” versus “outside-in” transobturator tapes in management of stress urinary incontinence in women

Cited by 27 publications

References 27 publications

Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis

Medium-term and long-term outcomes following placement of midurethral slings for stress urinary incontinence: a systematic review and metaanalysis

Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta‐analysis of randomised trials

Inside‐out versus outside‐in transobturator tension‐free vaginal tape: A 5‐year prospective comparative study

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