Surgical Treatment for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis

Abstract

Objective To compare surgical treatments for stress urinary incontinence in terms of efficiency and complications. Data Sources We searched the MEDLINE and COCHRANE databases using the terms stress urinary incontinence, surgical treatment for stress urinary incontinence and sling. Selection of Studies Forty-eight studies were selected, which amounted to a total of 6,881 patients with scores equal to or higher than 3 in the Jadad scale. Data Collection Each study was read by one of the authors, added to a standardized table and checked by a second author. We extracted data on intervention details, follow-up time, the results of treatment and adverse events. Data Synthesis Comparing retropubic versus transobturator slings, the former was superior for both objective (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.05-1.54) and subjective (OR, 1.23; 95% CI, 1.02-1.48) cures. Between minislings versus other slings, there was a difference favoring other slings for subjective cure (OR, 0.58; 95% CI, 0.39-0.86). Between pubovaginal sling versus Burch surgery, there was a difference for both objective (OR, 2.04; 95% CI, 1.50-2.77) and subjective (OR, 1.64; 95% CI, 1.10-2.44) cures, favoring pubovaginal sling. There was no difference in the groups: midurethral slings versus Burch, pubovaginal sling versus midurethral slings, transobturator slings, minislings versus other slings (objective cure). Retropubic and pubovaginal slings are more retentionist. Retropubic slings have more bladder perforation, and transobturator slings, more leg and groin pain, neurological lesion and vaginal perforation. Conclusion Pubovaginal slings are superior to Burch colposuspension surgery but exhibit more retention. Retropubic slings are superior to transobturator slings, with more adverse events. Other slings are superior to minislings in the subjective aspect. There was no difference in the comparisons between midurethral slings versus Burch colposuspension surgery, pubovaginal versus midurethral slings, and inside-out versus outside-in transobturator slings.

The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country

“…A meta-analysis of colposuspension and MUS demonstrated significantly higher overall and objective cure rates with MUS but a higher risk of bladder perforation in retropubic slings as compared to TOT. 8 A regional study from Turkey showed that TOT is associated with improved objective cure rates of SUI and QOL. 9 Similarly a local study from Pakistan revealed that TVT is an effective and safe procedure for the surgical treatment of SUI.…”

Eficácia da Técnica de Colpossuspensão a Burch Laparoscópica para o Tratamento da Incontinência Urinária de Esforço: Uma Revisão Sistemática / Efficacy of the Colpossuspension Technique to Laparoscopic Burch for the Treatment of Stress Urinary Incontinence: A Systematic Review

“…Em uma revisão sistemática com metanálise englobando 16 estudos totalizando 2646 mulheres, as taxas de cura objetiva e subjetiva nos casos de IUE foram equivalente quando comparados os sling RP e TOT (OR 1,07, IC 95% 0,68-1,68) e a cura subjetiva no grupo transobturador (TOT) em comparação com a do grupo RP também não foi estatisticamente significante (OR 1,05, IC de 95% 0,37-2,99) (SUN et al, 2015). Uma revisão sistemática de 48 estudos com metanálise totalizando 6.881 pacientes que o sling RP foi superior ao sling TOT quanto as taxas de cura objetiva (RC: 1,27; IC95%:1,05 -1,54) e subjetiva (RC:1,23; IC95%1,02-1,48) (OLIVEIRA et al,2018).…”

Position of the Ibero‐American Society of Neurourology and Urogynecology in relation to the use of synthetic suburethral meshes for the surgical treatment of female stress incontinence

“…Although some published studies have described persistent pain in the groin or thigh after placement of transobturator MUS, passing or transient pain is more common, occurring in 5% to 31% of patients. These results can be partially attributed to the fact they were reported in studies of personal series with short follow‐up times; pain is more common in the first 2 weeks, affecting 30% of patients but diminishing significantly at 6 months, and more specifically 5.1% in TOT and 3.1% in TVT patients, and only requiring pharmacological analgesia in 1% of cases . Infection is rare, affecting less than 1.6% of all cases .…”

“…These results can be partially attributed to the fact they were reported in studies of personal series with short follow-up times; pain is more common in the first 2 weeks, affecting 30% of patients but diminishing significantly at 6 months, and more specifically 5.1% in TOT and 3.1% in TVT patients, and only requiring pharmacological analgesia in 1% of cases. [18][19][20] Infection is rare, affecting less than 1.6% of all cases. 15 The complication rate has been shown to vary according to the experience and the learning curve of the surgeon, this being a determining factor in these cases.…”