Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence

a meta-analysis of effectiveness and complications

Mohamed Abdel-Fattah, John A. Ford, Chou Phay Lim, Priya Madhuvrata

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Context
Single-incision mini-slings (SIMS) have been introduced for the treatment of female stress urinary incontinence (SUI); however, concerns have been raised regarding their efficacy. No systematic reviews or meta-analyses have previously assessed these relatively new procedures.

Objective
To assess the current evidence of effectiveness and safety of SIMS compared with standard midurethral slings (SMUS) (retropubic and transobturator tension-free vaginal tapes) in the management of female SUI.

Evidence acquisition
We conducted a literature search from 1996 to January 2011. Meta-analysis of all randomised controlled trials (RCTs) comparing SIMS versus SMUS was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were analysed using Rev-Man 5. Primary outcomes were patient-reported and objective cure rates. Secondary outcomes included perioperative complications, quality of life (QoL) changes, and costs to health services.

Evidence synthesis
A total of 758 women in nine RCTs with a mean follow-up of 9.5 mo were included. The mean age (52.3 vs 52.1 yr), body mass index (27.4 vs 27.7), and parity (2.4 and 2.4) were comparable for both groups. SIMS were associated with significantly lower patient-reported and objective cure rates at 6–12 mo compared with SMUS (risk ratio [RR]: 0.83; 95% confidence interval [CI], 0.70–0.99, and RR: 0.85; 95% CI, 0.74–0.97, respectively). SIMS were associated with significantly shorter operative time (weighed mean difference [WMD]: 8.67 min; 95% CI, 17.32 to −0.02), lower day 1 pain scores (WMD: 1.74; 95% CI, −2.58 to −0.09), and less postoperative groin pain (RR: 0.18; 95% CI, 0.04–0.72). Repeat continence surgery (RR: 6.72; 95% CI, 2.39–18.89) and de novo urgency incontinence (RR: 2.08; 95% CI, 1.01–4.28) were significantly higher in the SIMS group. There was no significant difference in the QoL scores between the groups (WMD: 33.46; 95% CI, −20.62 to 87.55). No studies compared cost to health services.

Conclusions
SIMS are associated with inferior patient-reported and objective cure rates on the short-term follow-up, as well as higher reoperation rates for SUI when compared with SMUS.
Original languageEnglish
Pages (from-to)468-480
Number of pages13
JournalEuropean Urology
Volume60
Issue number3
Early online date24 May 2011
DOIs
Publication statusPublished - Sep 2011

Fingerprint

Suburethral Slings
Stress Urinary Incontinence
Meta-Analysis
Confidence Intervals
Odds Ratio
Reoperation
Health Services
Randomized Controlled Trials
Quality of Life
Costs and Cost Analysis
Groin
Operative Time
Postoperative Pain
Parity
Body Mass Index
Safety
Pain

Keywords

  • stress urinary incontinence
  • single incision tapes
  • mini-slings
  • tension free vaginal tapes
  • transobturator tapes

Cite this

Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence : a meta-analysis of effectiveness and complications. / Abdel-Fattah, Mohamed; Ford, John A.; Lim, Chou Phay; Madhuvrata, Priya.

In: European Urology, Vol. 60, No. 3, 09.2011, p. 468-480 .

Research output: Contribution to journalArticle

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abstract = "ContextSingle-incision mini-slings (SIMS) have been introduced for the treatment of female stress urinary incontinence (SUI); however, concerns have been raised regarding their efficacy. No systematic reviews or meta-analyses have previously assessed these relatively new procedures.ObjectiveTo assess the current evidence of effectiveness and safety of SIMS compared with standard midurethral slings (SMUS) (retropubic and transobturator tension-free vaginal tapes) in the management of female SUI.Evidence acquisitionWe conducted a literature search from 1996 to January 2011. Meta-analysis of all randomised controlled trials (RCTs) comparing SIMS versus SMUS was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were analysed using Rev-Man 5. Primary outcomes were patient-reported and objective cure rates. Secondary outcomes included perioperative complications, quality of life (QoL) changes, and costs to health services.Evidence synthesisA total of 758 women in nine RCTs with a mean follow-up of 9.5 mo were included. The mean age (52.3 vs 52.1 yr), body mass index (27.4 vs 27.7), and parity (2.4 and 2.4) were comparable for both groups. SIMS were associated with significantly lower patient-reported and objective cure rates at 6–12 mo compared with SMUS (risk ratio [RR]: 0.83; 95{\%} confidence interval [CI], 0.70–0.99, and RR: 0.85; 95{\%} CI, 0.74–0.97, respectively). SIMS were associated with significantly shorter operative time (weighed mean difference [WMD]: 8.67 min; 95{\%} CI, 17.32 to −0.02), lower day 1 pain scores (WMD: 1.74; 95{\%} CI, −2.58 to −0.09), and less postoperative groin pain (RR: 0.18; 95{\%} CI, 0.04–0.72). Repeat continence surgery (RR: 6.72; 95{\%} CI, 2.39–18.89) and de novo urgency incontinence (RR: 2.08; 95{\%} CI, 1.01–4.28) were significantly higher in the SIMS group. There was no significant difference in the QoL scores between the groups (WMD: 33.46; 95{\%} CI, −20.62 to 87.55). No studies compared cost to health services.ConclusionsSIMS are associated with inferior patient-reported and objective cure rates on the short-term follow-up, as well as higher reoperation rates for SUI when compared with SMUS.",
keywords = "stress urinary incontinence, single incision tapes, mini-slings , tension free vaginal tapes, transobturator tapes",
author = "Mohamed Abdel-Fattah and Ford, {John A.} and Lim, {Chou Phay} and Priya Madhuvrata",
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T1 - Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence

T2 - a meta-analysis of effectiveness and complications

AU - Abdel-Fattah, Mohamed

AU - Ford, John A.

AU - Lim, Chou Phay

AU - Madhuvrata, Priya

PY - 2011/9

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N2 - ContextSingle-incision mini-slings (SIMS) have been introduced for the treatment of female stress urinary incontinence (SUI); however, concerns have been raised regarding their efficacy. No systematic reviews or meta-analyses have previously assessed these relatively new procedures.ObjectiveTo assess the current evidence of effectiveness and safety of SIMS compared with standard midurethral slings (SMUS) (retropubic and transobturator tension-free vaginal tapes) in the management of female SUI.Evidence acquisitionWe conducted a literature search from 1996 to January 2011. Meta-analysis of all randomised controlled trials (RCTs) comparing SIMS versus SMUS was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were analysed using Rev-Man 5. Primary outcomes were patient-reported and objective cure rates. Secondary outcomes included perioperative complications, quality of life (QoL) changes, and costs to health services.Evidence synthesisA total of 758 women in nine RCTs with a mean follow-up of 9.5 mo were included. The mean age (52.3 vs 52.1 yr), body mass index (27.4 vs 27.7), and parity (2.4 and 2.4) were comparable for both groups. SIMS were associated with significantly lower patient-reported and objective cure rates at 6–12 mo compared with SMUS (risk ratio [RR]: 0.83; 95% confidence interval [CI], 0.70–0.99, and RR: 0.85; 95% CI, 0.74–0.97, respectively). SIMS were associated with significantly shorter operative time (weighed mean difference [WMD]: 8.67 min; 95% CI, 17.32 to −0.02), lower day 1 pain scores (WMD: 1.74; 95% CI, −2.58 to −0.09), and less postoperative groin pain (RR: 0.18; 95% CI, 0.04–0.72). Repeat continence surgery (RR: 6.72; 95% CI, 2.39–18.89) and de novo urgency incontinence (RR: 2.08; 95% CI, 1.01–4.28) were significantly higher in the SIMS group. There was no significant difference in the QoL scores between the groups (WMD: 33.46; 95% CI, −20.62 to 87.55). No studies compared cost to health services.ConclusionsSIMS are associated with inferior patient-reported and objective cure rates on the short-term follow-up, as well as higher reoperation rates for SUI when compared with SMUS.

AB - ContextSingle-incision mini-slings (SIMS) have been introduced for the treatment of female stress urinary incontinence (SUI); however, concerns have been raised regarding their efficacy. No systematic reviews or meta-analyses have previously assessed these relatively new procedures.ObjectiveTo assess the current evidence of effectiveness and safety of SIMS compared with standard midurethral slings (SMUS) (retropubic and transobturator tension-free vaginal tapes) in the management of female SUI.Evidence acquisitionWe conducted a literature search from 1996 to January 2011. Meta-analysis of all randomised controlled trials (RCTs) comparing SIMS versus SMUS was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were analysed using Rev-Man 5. Primary outcomes were patient-reported and objective cure rates. Secondary outcomes included perioperative complications, quality of life (QoL) changes, and costs to health services.Evidence synthesisA total of 758 women in nine RCTs with a mean follow-up of 9.5 mo were included. The mean age (52.3 vs 52.1 yr), body mass index (27.4 vs 27.7), and parity (2.4 and 2.4) were comparable for both groups. SIMS were associated with significantly lower patient-reported and objective cure rates at 6–12 mo compared with SMUS (risk ratio [RR]: 0.83; 95% confidence interval [CI], 0.70–0.99, and RR: 0.85; 95% CI, 0.74–0.97, respectively). SIMS were associated with significantly shorter operative time (weighed mean difference [WMD]: 8.67 min; 95% CI, 17.32 to −0.02), lower day 1 pain scores (WMD: 1.74; 95% CI, −2.58 to −0.09), and less postoperative groin pain (RR: 0.18; 95% CI, 0.04–0.72). Repeat continence surgery (RR: 6.72; 95% CI, 2.39–18.89) and de novo urgency incontinence (RR: 2.08; 95% CI, 1.01–4.28) were significantly higher in the SIMS group. There was no significant difference in the QoL scores between the groups (WMD: 33.46; 95% CI, −20.62 to 87.55). No studies compared cost to health services.ConclusionsSIMS are associated with inferior patient-reported and objective cure rates on the short-term follow-up, as well as higher reoperation rates for SUI when compared with SMUS.

KW - stress urinary incontinence

KW - single incision tapes

KW - mini-slings

KW - tension free vaginal tapes

KW - transobturator tapes

U2 - 10.1016/j.eururo.2011.05.003

DO - 10.1016/j.eururo.2011.05.003

M3 - Article

VL - 60

SP - 468

EP - 480

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 3

ER -