Clinical outcome of single-incision slings, excluding TVT-Secur, vs standard slings in the surgical management of stress incontinence: an updated systematic review and meta-analysis.

Abstract

The aim of the present paper was to assess and compare the long-term efficacy and safety of single-incision mini-slings (SIMSs), except tension-free vaginal tape (TVT)-Secur, with standard midurethral slings (SMUSs) for female stress urinary incontinence through an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing these two surgical methods. A literature review of all RCTs comparing SIMSs (Mini-Arc, Contasure-Needleless, Ophira, Tissue Fixation System and Ajust), except TVT-Secur, with SMUSs was performed. The Medline, Embase, Scopus, Web of Science and Cochrane Controlled Trial Register databases were reviewed. We retrieved 29 RCTs (including a total of 2 986 patients) that compared SIMSs, except TVT-Secur, with SMUSs. Meta-analysis of long-term results showed no significant difference in the patient-reported cure rate (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.44-1.60); however, we found that SMUSs had a significantly superior objective cure rate (OR 0.68, 95% CI 0.47-0.99; P = 0.04). SIMSs were associated with a significantly shorter operation time, lower immediate postoperative pain based on a visual analogue scale score, lower intra-operative blood loss, and lower postoperative voiding dysfunction. The meta-analysis showed clear evidence of the superiority of SMUSs over SIMSs, except TVT-Secur, in terms of the objective cure rate, after long-term follow-up; however, SIMSs were superior with respect to immediate postoperative pain, intra-operative blood loss, and postoperative voiding dysfunction.

• Authors: Aram Kim, Min Seo Kim, Young-Jin Park, Woo Suk Choi, Hyoung Keun Park, Sung Hyun Paick, Myung-Soo Choo, Hyeong Gon Kim
• Journal: BJU international (BJU Int) Vol. 123 Issue 4 Pg. 566-584 (04 2019) ISSN: 1464-410X [Electronic] England
• PMID: 29927049 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Topics

• Female
• Humans
• Postoperative Period
• Randomized Controlled Trials as Topic
• Suburethral Slings
• Treatment Outcome
• Urinary Incontinence, Stress (surgery)
• Urologic Surgical Procedures (methods)