TY - JOUR
T1 - Surgical Treatment of Recurrent Stress Urinary Incontinence in Women
T2 - A Systematic Review and Meta-analysis of Randomised Controlled Trials
AU - Agur, Wael
AU - Riad, Mohamed
AU - Secco, Silvia
AU - Litman, Heather
AU - Madhuvrata, Priya
AU - Novara, Giacomo
AU - Abdel-Fattah, Mohamed
N1 - We would like to thank all the authors who responded to us and those who provided their study data. Special thanks goes to Dr Karen Bell, Head of Research and Development, Julie Wands, Library Manager, NHS Ayrshire and Arran, and Ms Genevieve Cseh, Research PA, University of Aberdeen, for logistic and administrative support.
PY - 2013/8
Y1 - 2013/8
N2 - Context Recurrent stress urinary incontinence (R-SUI) represents a management dilemma; however, only a limited number of randomised controlled trials (RCTs) have assessed the various surgical procedures used for its treatment. Objective To assess the effectiveness and complications of various surgical procedures for the treatment of female R-SUI.Evidence acquisition A prospective peer-reviewed protocol was prepared a priori. A systematic literature review of all published RCTs comparing surgical procedures for treatment of R-SUI was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Data were analysed using RevMan 5. Evidence synthesis We conducted a literature search from 1945 to February 2013. Data were available for a total of 350 women in 10 RCTs with a mean follow-up of 18.1 mo. Meta-analysis was possible for the comparison of retropubic tension-free vaginal tape (RP-TVT) versus transobturator tension-free vaginal tape (TO-TVT) in five RCTs (n = 135). There was no statistically significant difference between RP-TVT and TO-TVT in the patient-reported improvement (odds ratio [OR]: 0.84, 95% confidence interval [CI], 0.41-1.69) or objective cure/improvement (OR: 1.75; 95% CI, 0.86-3.54). One RCT showed a trend towards a higher rate of patient-reported and objective cure/improvement with the inside-out TO-TVT compared with the outside-in; however, it was not statistically significant (OR: 3.00; 95% CI, 0.85-10.57, and OR: 3.32; 95% CI, 0.96-11.41, respectively). There was no significant difference between Burch colposuspension and RP-TVT (one RCT) in patient-reported improvement (OR: 0.33; 95% CI, 0.01-8.57) or objective cure/improvement (OR: 0.52; 95% CI, 0.13-2.05). Conclusions This meta-analysis shows no evidence of a significant difference in patient-reported and objective cure/improvement rates between RP-TVT and TO-TVT in the surgical treatment of women with R-SUI. However, due to the relatively low number of patients, the analysis might be underpowered. This review highlights the poor level of evidence in this field and the need for well-designed clinical trials to address this important clinical dilemma.
AB - Context Recurrent stress urinary incontinence (R-SUI) represents a management dilemma; however, only a limited number of randomised controlled trials (RCTs) have assessed the various surgical procedures used for its treatment. Objective To assess the effectiveness and complications of various surgical procedures for the treatment of female R-SUI.Evidence acquisition A prospective peer-reviewed protocol was prepared a priori. A systematic literature review of all published RCTs comparing surgical procedures for treatment of R-SUI was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Data were analysed using RevMan 5. Evidence synthesis We conducted a literature search from 1945 to February 2013. Data were available for a total of 350 women in 10 RCTs with a mean follow-up of 18.1 mo. Meta-analysis was possible for the comparison of retropubic tension-free vaginal tape (RP-TVT) versus transobturator tension-free vaginal tape (TO-TVT) in five RCTs (n = 135). There was no statistically significant difference between RP-TVT and TO-TVT in the patient-reported improvement (odds ratio [OR]: 0.84, 95% confidence interval [CI], 0.41-1.69) or objective cure/improvement (OR: 1.75; 95% CI, 0.86-3.54). One RCT showed a trend towards a higher rate of patient-reported and objective cure/improvement with the inside-out TO-TVT compared with the outside-in; however, it was not statistically significant (OR: 3.00; 95% CI, 0.85-10.57, and OR: 3.32; 95% CI, 0.96-11.41, respectively). There was no significant difference between Burch colposuspension and RP-TVT (one RCT) in patient-reported improvement (OR: 0.33; 95% CI, 0.01-8.57) or objective cure/improvement (OR: 0.52; 95% CI, 0.13-2.05). Conclusions This meta-analysis shows no evidence of a significant difference in patient-reported and objective cure/improvement rates between RP-TVT and TO-TVT in the surgical treatment of women with R-SUI. However, due to the relatively low number of patients, the analysis might be underpowered. This review highlights the poor level of evidence in this field and the need for well-designed clinical trials to address this important clinical dilemma.
KW - Colposuspension
KW - Complications
KW - Recurrent urinary incontinence
KW - Suburethral slings
KW - Tension-free vaginal tape
KW - Transobturator tape
KW - Urodynamic stress incontinence
UR - http://www.scopus.com/inward/record.url?scp=84879994922&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2013.04.034
DO - 10.1016/j.eururo.2013.04.034
M3 - Article
C2 - 23680414
AN - SCOPUS:84879994922
VL - 64
SP - 323
EP - 336
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 2
ER -