Mid-urethral sling operations have been the most extensively researched surgical treatment for stress urinary incontinence (SUI) in women and have a good safety profile. Irrespective of the routes traversed, they are highly effective in the short and medium term, and accruing evidence demonstrates their effectiveness in the long term. This review illustrates their positive impact on improving the quality of life of women with SUI. However, a brief economic commentary (BEC) identified three studies suggesting that transobturator may be more cost-effective compared with retropubic. Fewer adverse events occur with employment of a transobturator approach with the exception of groin pain. When comparing transobturator techniques of a medial-to-lateral versus a lateral-to-medial insertion, there is no evidence to support the use of one approach over the other. However, a bottom-to-top route was more effective than top-to-bottom route for retropubic tapes.A salient point illustrated throughout this review is the need for reporting of longer-term outcome data from the numerous existing trials. This would substantially increase the evidence base and provide clarification regarding uncertainties about long-term effectiveness and adverse event profile.

The available evidence base remains insufficient to guide practice. In addition, the finding that placebo saline injection was followed by a similar symptomatic improvement to bulking agent injection raises questions about the mechanism of any beneficial effects. One small trial comparing silicone particles with pelvic floor muscle training was suggestive of benefit at three months but it is not known if this was sustained, and the treatment was associated with high levels of postoperative retention and dysuria. Greater symptomatic improvement was observed with surgical treatments, though the advantages need to be set against likely higher risks. No clear-cut conclusions could be drawn from trials comparing alternative agents, although dextranomer hyaluronic acid was associated with more local side effects and is no longer commercially available for this indication. There is insufficient evidence to show superiority of mid-urethral or bladder neck injection. The single trial of autologous fat provides a reminder that periurethral injections can occasionally cause serious side effects. Also, a Brief Economic Commentary (BEC) identified three studies suggesting that urethral bulking agent might be more cost-effective compared with retropubic mid-urethral slings, transobturator or traditional sling procedure when used as an initial treatment in women without hypermobility or as a follow-up to surgery failure provided injection is kept minimal. However, urethral bulking agent might not be cost-effective when compared with traditional sling as an initial treatment of SUI when a patient is followed up for a longer period (15 months post-surgery).

This is the published version of the paper.This version of the publication may differ from the final published version. Permanent repository link: T A B L E O F C O N T E N T S A B S T R A C TThis is the protocol for a review and there is no abstract. The objectives are as follows:The primary objective of the review is to assess the effectiveness of intervention components that seek to increase attendance for diabetic retinopathy screening in people with type 1 and type 2 diabetes. Secondary objectives:• To use validated taxonomies of QI intervention strategies and behaviour change techniques (BCTs) to code the description of interventions in the included studies and determine whether interventions that include particular QI strategies or component BCTs are more effective in increasing screening attendance;• To explore heterogeneity in effect size within and between studies to identify potential explanatory factors for variability in effect size;• To explore differential effects in subgroups to provide information on how equity of screening attendance could be improved;• To critically appraise and summarise current evidence on the resource use, costs and cost-effectiveness. There is limited evidence on the economic burden of diabetic retinopathy. One recent estimate for healthcare costs in Sweden was EUR 106,000 per 100,000 population per year based upon a prevalence of diabetes of 4.8% (95% confidence interval 4.7 to 4.9) (Heintz 2010). These costs exclude cost impacts on those with diabetic retinopathy and their families. Although effective treatments are available for sight-threatening diabetic retinopathy in the form of laser photocoagulation (Evans 2014) and more recently the use of anti-vascular endothelial growth factor inhibitors (Virgili 2014), the success of these interventions is dependent on early detection and timely referral for treatment. Diabetic retinopathy screening fulfils the World Health Organization (WHO) criteria for a screening programme (Scanlon 2008): namely, diabetes-associated visual impairment is an important public health problem; potentially sight-threatening retinopathy has a recognisable latent stage; a universally accepted and effective treatment is available; and screening has been shown to be cost-effective in terms of sight years preserved compared with no screening (Jones 2010). Annual or biennial diabetic retinopathy screening is recommended in many countries using a variety of screening modalities including: ophthalmoscopy performed by a number of healthcare professionals (including ophthalmologists, optometrists, diabetic physicians) or using standard retinal photography or digital fundus imaging (American Diabetes Association 2015; Kristinsson 1995; Scanlon 2008). However, relatively few countries have introduced a national population-based diabetic retinopathy screening programme and in most parts of the world screening remains non-systematic. The reference standard for the detection of diabetic retinopathy consists of seven standard 35-degree colour photographic fie...

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