Updated Systematic Review and Meta-analysis of the Comparative Data on Colposuspensions, Pubovaginal Slings, and Midurethral Tapes in the Surgical Treatment of Female Stress Urinary Incontinence

Abstract

CONTEXT: Retropubic (RT-TVT) and transobturator miurethral (TO-TVT) mid-urethral sling (MUS) are popular surgical treatments for female stress urinary incontinence (SUI). The long-term efficacy and safety of the procedures is still a topic of intense clinical research and several randomized controlled trials (RCTs) have been published in the last years OBJECTIVE: To evaluate the efficacy and safety of MUS compared with other surgical treatments for female SUI. EVIDENCE ACQUISITION:A systematic review and meta-analysis of the literature was performed using the Medline, Scopus, and Web of Science databases to update our previously published analyses. EVIDENCE SYNTHESIS:Twenty-eight RCTs were identified. In total, the meta-analyses CONCLUSIONS:The present analysis confirms the superiority of MUS over BC. The studies comparing insertion of RT-TVT and TO-TVT showed higher subjective and objective cure rates for the RP-TVT but at the cost of higher risks of some complications and voiding LUTS. Efficacy of 3 inside-out and outside-in techniques of TO-TVT insertion was similar, although the risk of vaginal perforation was lower in the inside-to-out TO-TVT. PATIENT SUMMARY:Retropubic and transobturator midurethral slings are a popular treatment for female stress urinary incontinence. The available literature suggest that those slings are either more effective or safer than other older surgical procedures. Retropubic tapes are followed with slightly higher continence rates as compared with the transobturator tapes but are associated with higher risk of intra-and postoperative complications. TAKE-HOME MESSAGESThe present analysis confirms the superiority of MUS over Burch colposuspension. The studies comparing insertion of RT-TVT and TO-TVT showed higher subjective and objective cure rates for the RP-TVT but at the cost of higher risks of some complications and voiding LUTS. Efficacy of inside-out and outside-in techniques of TO-TVT insertion was similar, although the risk of vaginal perforation was lower in the inside-to-out TO-TVT 4

Renaissance of the autologous pubovaginal sling

“…More recently, the operation has been successfully used for primary SUI, as continence rates were better with greater patient satisfaction despite the higher incidence of postoperative voiding dysfunction compared with Burch colposuspension [3]. This finding is supported by results of a recent meta-analysis of 15,855 patients showing that both synthetic and PVS had similar objective cure rates that were superior to Burch colposuspension [4].…”

Bladder neck placement of a synthetic polypropylene sling for the treatment of stress urinary incontinence

“…Deval et al (23) and Ulmsten et al (18) reported subjective cure rates of 70% and 85% respectively in large studies on TVT for SUI , and cure rates of 74% have been reported on mid-urethral TVT for ISD (17). A recent systematic review of surgical treatments of SUI demonstrated similar cure rates in the MUS and RFS group and a trend towards a higher re-operation rate in the MUS group (24). Our subjective cure rate of 85% with bladder neck placement, after median 4 year follow up, compares favorably with the literature (Table 4).…”

Re: Renaissance of the autologous pubovaginal sling

“…The authors have correctly cited the conclusion of the systematic review by Fusco et al [2], suggesting that, with regard to objective cure rates, synthetic slings might have been superior to Burch colposuspension. I would like to draw the authors' attention to a recent letter and reply [3] that questioned such a conclusion, particularly as the relevant Cochrane review [4] had concluded that there was no significant difference in the objective outcomes between synthetic slings and colposuspension.…”

“…The cited systematic review [2] had included a trial of Blaparoscopic^colposuspension among the Bopenĝ roup and had applied meta-analysis to a secondary, rather than the primary, outcome of the Ward and Hilton study [5], the main RCT in the open group. Outcome switching could have been the reason behind a conclusion that is in variance with the Cochrane Review.…”