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

Synthetic slings can be safely used in the surgical treatment of stress incontinence in both male and female patients. Patients need to be aware of the alternative therapy and potential risks and complications of this therapy. Synthetic mesh for treating prolapse should be used only in complex cases with recurrent prolapse in specialist referral centres.

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