Adjustable single-incision mini-slings (Ajust®) versus other slings in surgical management of female stress urinary incontinence: a meta-analysis of effectiveness and complications

Abstract

BackgroundAdjustable single-incision mini-sling (SIMS) is a new category of SIMS for stress urinary incontinence (SUI). The aim of this study was to compare the efficacy and safety of adjustable single-incision mini-sling with other slings.MethodsLiterature search in databases such as Pubmed, and Conchrane Library was performed up to December, 2015. The outcomes including cure rate, operation time, postoperative pain score and complications were reanalyzed. The pooled relative risk (RR) and mean difference (MD) with their 95% confidence interval (95% CI) were calculated by RevMan v5.0.ResultsEight studies with 1093 SUI female patients were included. There was no significant difference between adjustable SIMS and other slings (transobturator slings and MiniArc) in patients subjective cure rate and objective cure rate. In addition, adjustable SIMS was associated with a significantly shorter operative time and lower postoperative pain score when comparing adjustable SIMS with transobturator tape (MD = − 1.35; 95%CI: -2.24 to − 0.46, P = 0.003). For the complications, there was also no significant difference between adjustable SIMS and transobturator slings.ConclusionsAdjustable SIMS had equally efficacy for SUI compared with transobturator slings and MiniArc. However, the significantly shorter operative time and lower postoperative pain score than transobturator tape supported the clinical application of adjustable SIMS.

Comparison of Two Single-Incision Mini-Slings for the Treatment of Incontinence

“…In this study, the total cure rates were observed to be 89.1 and 86.9% in groups 1 and 2, respectively. The short-term cure rates of SIMS systems range between 89.4 and 94.4% in the literature, and these rates, including ours, are comparable with the results of the conventional transobturator MUS surgeries [7, 13-17].…”

“…SIMS surgeries have a significant advantage of short operation duration and applicability under local or epidural anesthesia [7, 16, 17]. Literature data show that the mean operation durations vary between 7 and 13 min [14, 22].…”

“…The 1st developed ones, such as TVT-Secur TM (Ethicon, Inc., Somerville, NJ, USA) and MiniArc® (American Medical Systems, Inc., Minnetonka, MN, USA), were tension free, and the efficacy of these SIMS systems was limited. Then, the adjustable SIMS systems were developed as a new category, which provide an insertion of the mesh into the obturator internus muscle/membrane with different types of anchorage systems and also enable adjustment of the tape after the insertion [7]. The most crucial expectation in the development of SIMS surgeries is the low rate of serious complications due to the applicability with minimal dissection and absence of blind retropubic or groin muscle trajectories.…”

“…The most crucial expectation in the development of SIMS surgeries is the low rate of serious complications due to the applicability with minimal dissection and absence of blind retropubic or groin muscle trajectories. Although there remain some controversial results regarding the short- and intermediate-term efficacy of the SIMS systems, some recent studies suggest that SIMS surgeries have comparable results with the MUS surgeries [7-9]. This study aimed to compare the safety and efficacy of the 2 SIMS systems with different designs of anchoring mechanism.…”

Single-incision mini-sling for the treatment of female stress urinary incontinence: Is it actually inferior to transobturator vaginal tape and tension-free vaginal tape?

“…[ 13 ] So far, there is no consensus regarding long-term outcomes of SIMS for women with SUI. Some authors report comparable outcomes of SIMS for woman with SUI,[ 14 15 16 ] but other authors report inferior outcomes as compared to TOT and TVT. [ 17 18 ] Based on the lack of robust evidence to draw firm conclusion, our study was aimed to compare cure rates, urogynecological symptoms, complications, patient satisfaction and safety of SISM, TVT, and TOT procedures for female SUI.…”