Single-Incision Mini-Slings Versus Standard Midurethral Slings in Surgical Management of Female Stress Urinary Incontinence

An Updated Systematic Review and Meta-analysis of Effectiveness and Complications

Alyaa Mostafa, Chou Phay Lim, Laura Hopper, Priya Madhuvrata, Mohamed Abdel-Fattah*

*Corresponding author for this work

Research output: Contribution to journalLiterature review

92 Citations (Scopus)

Abstract

Context: An updated systematic review and meta-analysis of randomised controlled trials (RCTs) comparing single-incision mini-slings (SIMS) versus standard midurethral slings (SMUS) in the surgical management of female stress urinary incontinence (SUI).

Objective: To evaluate the clinical efficacy, safety, and cost effectiveness of SIMS compared with SMUS in the treatment of female SUI.

Evidence acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing SIMS with either transobturator tension-free vaginal tape (TO-TVT) or retropubic tension-free vaginal tape (RP-TVT). The literature search had no language restrictions and was last updated on May 2, 2013. The primary outcomes were patient-reported and objective cure rates at 12 to 36 mo follow-up. Secondary outcomes included operative data; peri-and postoperative complications, and repeat continence surgery. Data were analysed using RevMan software. Meta-analyses of TVT-Secur versus SMUS are presented separately as the former was recently withdrawn from clinical practice.

Evidence synthesis: A total of 26 RCTs (n = 3308 women) were included. After excluding RCTs evaluating TVT-Secur, there was no evidence of significant differences between SIMS and SMUS in patient-reported cure rates (risk ratio [RR]: 0.94; 95% confidence interval [CI], 0.88-1.00) and objective cure rates (RR: 0.98; 95% CI, 0.94-1.01) at a mean follow-up of 18.6 mo. These results pertained on comparing SIMS versus TO-TVT and RP-TVT separately. SIMS had significantly lower postoperative pain scores (weighted means difference [WMD]: -2.94; 95% CI, -4.16 to -1.73) and earlier return to normal activities and to work (WMD: -5.08; 95% CI, -9.59 to -0.56 and WMD: -7.20; 95% CI, -12.43 to -1.98, respectively). SIMS had a nonsignificant trend towards higher rates of repeat continence surgery (RR: 2.00; 95% CI, 0.93-4.31).

Conclusions: This meta-analysis shows that, excluding TVT-Secur, there was no evidence of significant differences in patient-reported and objective cure between currently used SIMS and SMUS at midterm follow-up while associated with more favourable recovery time. Results should be interpreted with caution due to the heterogeneity of the trials included. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.

Original languageEnglish
Pages (from-to)402-427
Number of pages26
JournalEuropean Urology
Volume65
Issue number2
Early online date29 Aug 2013
DOIs
Publication statusPublished - Feb 2014

Keywords

  • mini-slings
  • midurethral sling
  • stress urinary incontinence
  • single-incision tapes
  • tension-free vaginal tape
  • urinary incontinence
  • free vaginal tape
  • randomized-controlled-trial
  • 1-year follow-up
  • quality-of-life
  • TVT-SECUR
  • inside-out
  • multicenter
  • transobturator
  • efficacy
  • questionnaire

Cite this

@article{eed952a33f2b4d9483984b890685c607,
title = "Single-Incision Mini-Slings Versus Standard Midurethral Slings in Surgical Management of Female Stress Urinary Incontinence: An Updated Systematic Review and Meta-analysis of Effectiveness and Complications",
abstract = "Context: An updated systematic review and meta-analysis of randomised controlled trials (RCTs) comparing single-incision mini-slings (SIMS) versus standard midurethral slings (SMUS) in the surgical management of female stress urinary incontinence (SUI).Objective: To evaluate the clinical efficacy, safety, and cost effectiveness of SIMS compared with SMUS in the treatment of female SUI.Evidence acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing SIMS with either transobturator tension-free vaginal tape (TO-TVT) or retropubic tension-free vaginal tape (RP-TVT). The literature search had no language restrictions and was last updated on May 2, 2013. The primary outcomes were patient-reported and objective cure rates at 12 to 36 mo follow-up. Secondary outcomes included operative data; peri-and postoperative complications, and repeat continence surgery. Data were analysed using RevMan software. Meta-analyses of TVT-Secur versus SMUS are presented separately as the former was recently withdrawn from clinical practice.Evidence synthesis: A total of 26 RCTs (n = 3308 women) were included. After excluding RCTs evaluating TVT-Secur, there was no evidence of significant differences between SIMS and SMUS in patient-reported cure rates (risk ratio [RR]: 0.94; 95{\%} confidence interval [CI], 0.88-1.00) and objective cure rates (RR: 0.98; 95{\%} CI, 0.94-1.01) at a mean follow-up of 18.6 mo. These results pertained on comparing SIMS versus TO-TVT and RP-TVT separately. SIMS had significantly lower postoperative pain scores (weighted means difference [WMD]: -2.94; 95{\%} CI, -4.16 to -1.73) and earlier return to normal activities and to work (WMD: -5.08; 95{\%} CI, -9.59 to -0.56 and WMD: -7.20; 95{\%} CI, -12.43 to -1.98, respectively). SIMS had a nonsignificant trend towards higher rates of repeat continence surgery (RR: 2.00; 95{\%} CI, 0.93-4.31).Conclusions: This meta-analysis shows that, excluding TVT-Secur, there was no evidence of significant differences in patient-reported and objective cure between currently used SIMS and SMUS at midterm follow-up while associated with more favourable recovery time. Results should be interpreted with caution due to the heterogeneity of the trials included. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.",
keywords = "mini-slings, midurethral sling, stress urinary incontinence, single-incision tapes, tension-free vaginal tape, urinary incontinence, free vaginal tape, randomized-controlled-trial, 1-year follow-up, quality-of-life, TVT-SECUR, inside-out, multicenter, transobturator, efficacy, questionnaire",
author = "Alyaa Mostafa and Lim, {Chou Phay} and Laura Hopper and Priya Madhuvrata and Mohamed Abdel-Fattah",
year = "2014",
month = "2",
doi = "10.1016/j.eururo.2013.08.032",
language = "English",
volume = "65",
pages = "402--427",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "2",

}

TY - JOUR

T1 - Single-Incision Mini-Slings Versus Standard Midurethral Slings in Surgical Management of Female Stress Urinary Incontinence

T2 - An Updated Systematic Review and Meta-analysis of Effectiveness and Complications

AU - Mostafa, Alyaa

AU - Lim, Chou Phay

AU - Hopper, Laura

AU - Madhuvrata, Priya

AU - Abdel-Fattah, Mohamed

PY - 2014/2

Y1 - 2014/2

N2 - Context: An updated systematic review and meta-analysis of randomised controlled trials (RCTs) comparing single-incision mini-slings (SIMS) versus standard midurethral slings (SMUS) in the surgical management of female stress urinary incontinence (SUI).Objective: To evaluate the clinical efficacy, safety, and cost effectiveness of SIMS compared with SMUS in the treatment of female SUI.Evidence acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing SIMS with either transobturator tension-free vaginal tape (TO-TVT) or retropubic tension-free vaginal tape (RP-TVT). The literature search had no language restrictions and was last updated on May 2, 2013. The primary outcomes were patient-reported and objective cure rates at 12 to 36 mo follow-up. Secondary outcomes included operative data; peri-and postoperative complications, and repeat continence surgery. Data were analysed using RevMan software. Meta-analyses of TVT-Secur versus SMUS are presented separately as the former was recently withdrawn from clinical practice.Evidence synthesis: A total of 26 RCTs (n = 3308 women) were included. After excluding RCTs evaluating TVT-Secur, there was no evidence of significant differences between SIMS and SMUS in patient-reported cure rates (risk ratio [RR]: 0.94; 95% confidence interval [CI], 0.88-1.00) and objective cure rates (RR: 0.98; 95% CI, 0.94-1.01) at a mean follow-up of 18.6 mo. These results pertained on comparing SIMS versus TO-TVT and RP-TVT separately. SIMS had significantly lower postoperative pain scores (weighted means difference [WMD]: -2.94; 95% CI, -4.16 to -1.73) and earlier return to normal activities and to work (WMD: -5.08; 95% CI, -9.59 to -0.56 and WMD: -7.20; 95% CI, -12.43 to -1.98, respectively). SIMS had a nonsignificant trend towards higher rates of repeat continence surgery (RR: 2.00; 95% CI, 0.93-4.31).Conclusions: This meta-analysis shows that, excluding TVT-Secur, there was no evidence of significant differences in patient-reported and objective cure between currently used SIMS and SMUS at midterm follow-up while associated with more favourable recovery time. Results should be interpreted with caution due to the heterogeneity of the trials included. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.

AB - Context: An updated systematic review and meta-analysis of randomised controlled trials (RCTs) comparing single-incision mini-slings (SIMS) versus standard midurethral slings (SMUS) in the surgical management of female stress urinary incontinence (SUI).Objective: To evaluate the clinical efficacy, safety, and cost effectiveness of SIMS compared with SMUS in the treatment of female SUI.Evidence acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing SIMS with either transobturator tension-free vaginal tape (TO-TVT) or retropubic tension-free vaginal tape (RP-TVT). The literature search had no language restrictions and was last updated on May 2, 2013. The primary outcomes were patient-reported and objective cure rates at 12 to 36 mo follow-up. Secondary outcomes included operative data; peri-and postoperative complications, and repeat continence surgery. Data were analysed using RevMan software. Meta-analyses of TVT-Secur versus SMUS are presented separately as the former was recently withdrawn from clinical practice.Evidence synthesis: A total of 26 RCTs (n = 3308 women) were included. After excluding RCTs evaluating TVT-Secur, there was no evidence of significant differences between SIMS and SMUS in patient-reported cure rates (risk ratio [RR]: 0.94; 95% confidence interval [CI], 0.88-1.00) and objective cure rates (RR: 0.98; 95% CI, 0.94-1.01) at a mean follow-up of 18.6 mo. These results pertained on comparing SIMS versus TO-TVT and RP-TVT separately. SIMS had significantly lower postoperative pain scores (weighted means difference [WMD]: -2.94; 95% CI, -4.16 to -1.73) and earlier return to normal activities and to work (WMD: -5.08; 95% CI, -9.59 to -0.56 and WMD: -7.20; 95% CI, -12.43 to -1.98, respectively). SIMS had a nonsignificant trend towards higher rates of repeat continence surgery (RR: 2.00; 95% CI, 0.93-4.31).Conclusions: This meta-analysis shows that, excluding TVT-Secur, there was no evidence of significant differences in patient-reported and objective cure between currently used SIMS and SMUS at midterm follow-up while associated with more favourable recovery time. Results should be interpreted with caution due to the heterogeneity of the trials included. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.

KW - mini-slings

KW - midurethral sling

KW - stress urinary incontinence

KW - single-incision tapes

KW - tension-free vaginal tape

KW - urinary incontinence

KW - free vaginal tape

KW - randomized-controlled-trial

KW - 1-year follow-up

KW - quality-of-life

KW - TVT-SECUR

KW - inside-out

KW - multicenter

KW - transobturator

KW - efficacy

KW - questionnaire

U2 - 10.1016/j.eururo.2013.08.032

DO - 10.1016/j.eururo.2013.08.032

M3 - Literature review

VL - 65

SP - 402

EP - 427

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 2

ER -