Updated Systematic Review and Meta-analysis of the Comparative Data on Colposuspensions, Pubovaginal slings, and Midurethral tapes in the Surgical Treatment of Female Stress Urinary Incontinence

Ferdinando Fusco, Mohamed Abdel-Fattah, Christopher R. Chapple, Massimiliano Creta, Sabrina La Falce, David Waltregny, Giacomo Novara

Research output: Contribution to journalArticle

54 Citations (Scopus)
3 Downloads (Pure)

Abstract

Context: Retropubic (RP-TVT) and transobturator miurethral (TO-TVT) midurethral sling (MUS) are popular surgical treatments for female stress urinary incontinence. The long-term efficacy and safety of the procedures is still a topic of intense clinical research and several randomised controlled trials (RCTs) have been published in the last years.
Objective: To evaluate the efficacy and safety of MUS compared with other surgical treatments for female stress urinary incontinence.
Evidence acquisition: A systematic review and meta-analysis of the literature was performed using the Medline, Scopus, and Web of Science databases to update our previously published analyses.
Evidence synthesis: Twenty-eight RCTs were identified. In total, the meta-analyses included 15 855 patients. Patients receiving MUS had significantly higher overall (odds ratio [OR]: 0.59, p = 0.0003) and objective (OR: 0.51, p = 0.001) cure rates than those receiving Burch colposuspension. Patients undergoing MUS and pubovaginal slings had similar cure rates. Patients treated with RT-TVT had higher subjective (OR: 0.83, p = 0.03) and objective (OR: 0.82, p = 0.01) cure rates than those receiving TO-TVT. However, the latter had a lower risk of intraoperative bladder or vaginal perforation (OR: 2.4, p = 0.0002), pelvic haematoma (OR: 2.61, p = 0.002), urinary tract infections (OR: 1.31, p = 0.04) and voiding lower urinary tract symptoms (OR: 1.66, p = 0.002). Sensitivity analyses limited to RCTs with follow-up durations >60 mo demonstrated similar outcomes for RP-TVT and TO-TVT. No significant differences in efficacy were identified comparing inside-to-out and outside-to-in TO-TVT but vaginal perforations were less common with the former (OR: 0.21, p = 0.0002).
Conclusions: The present analysis confirms the superiority of MUS over Burch colposuspension. The studies comparing insertion of RT-TVT and TO-TVT showed higher subjective and objective cure rates for the RP-TVT but at the cost of higher risks of some complications and voiding lower urinary tract symptoms. Efficacy of inside-out and outside-in techniques of TO-TVT insertion was similar, although the risk of vaginal perforation was lower in the inside-to-out TO-TVT.
Patient summary: Retropubic and transobturator midurethral slings are a popular treatment for female stress urinary incontinence. The available literature suggest that those slings are either more effective or safer than other older surgical procedures. Retropubic tapes are followed with slightly higher continence rates as compared with the transobturator tapes but are associated with higher risk of intra- and postoperative complications.
Original languageEnglish
Pages (from-to)567-591
Number of pages25
JournalEuropean Urology
Volume72
Issue number4
Early online date4 May 2017
DOIs
Publication statusPublished - Oct 2017

Fingerprint

Surgical Tape
Suburethral Slings
Stress Urinary Incontinence
Meta-Analysis
Odds Ratio
Lower Urinary Tract Symptoms
Therapeutics
Randomized Controlled Trials
Safety
Intraoperative Complications
Urinary Tract Infections
Hematoma
Urinary Bladder

Keywords

  • Stress urinary incontinence
  • Burch colposuspension
  • Pubovaginal sling
  • Retropubic vaginal tape
  • Tension free tape
  • Transobturator tape

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Updated Systematic Review and Meta-analysis of the Comparative Data on Colposuspensions, Pubovaginal slings, and Midurethral tapes in the Surgical Treatment of Female Stress Urinary Incontinence. / Fusco, Ferdinando; Abdel-Fattah, Mohamed; Chapple, Christopher R.; Creta, Massimiliano; La Falce, Sabrina; Waltregny, David; Novara, Giacomo.

In: European Urology, Vol. 72, No. 4, 10.2017, p. 567-591.

Research output: Contribution to journalArticle

Fusco, Ferdinando ; Abdel-Fattah, Mohamed ; Chapple, Christopher R. ; Creta, Massimiliano ; La Falce, Sabrina ; Waltregny, David ; Novara, Giacomo. / Updated Systematic Review and Meta-analysis of the Comparative Data on Colposuspensions, Pubovaginal slings, and Midurethral tapes in the Surgical Treatment of Female Stress Urinary Incontinence. In: European Urology. 2017 ; Vol. 72, No. 4. pp. 567-591.
@article{d6a0acb252744d63a38ee1739d8f5566,
title = "Updated Systematic Review and Meta-analysis of the Comparative Data on Colposuspensions, Pubovaginal slings, and Midurethral tapes in the Surgical Treatment of Female Stress Urinary Incontinence",
abstract = "Context: Retropubic (RP-TVT) and transobturator miurethral (TO-TVT) midurethral sling (MUS) are popular surgical treatments for female stress urinary incontinence. The long-term efficacy and safety of the procedures is still a topic of intense clinical research and several randomised controlled trials (RCTs) have been published in the last years.Objective: To evaluate the efficacy and safety of MUS compared with other surgical treatments for female stress urinary incontinence.Evidence acquisition: A systematic review and meta-analysis of the literature was performed using the Medline, Scopus, and Web of Science databases to update our previously published analyses.Evidence synthesis: Twenty-eight RCTs were identified. In total, the meta-analyses included 15 855 patients. Patients receiving MUS had significantly higher overall (odds ratio [OR]: 0.59, p = 0.0003) and objective (OR: 0.51, p = 0.001) cure rates than those receiving Burch colposuspension. Patients undergoing MUS and pubovaginal slings had similar cure rates. Patients treated with RT-TVT had higher subjective (OR: 0.83, p = 0.03) and objective (OR: 0.82, p = 0.01) cure rates than those receiving TO-TVT. However, the latter had a lower risk of intraoperative bladder or vaginal perforation (OR: 2.4, p = 0.0002), pelvic haematoma (OR: 2.61, p = 0.002), urinary tract infections (OR: 1.31, p = 0.04) and voiding lower urinary tract symptoms (OR: 1.66, p = 0.002). Sensitivity analyses limited to RCTs with follow-up durations >60 mo demonstrated similar outcomes for RP-TVT and TO-TVT. No significant differences in efficacy were identified comparing inside-to-out and outside-to-in TO-TVT but vaginal perforations were less common with the former (OR: 0.21, p = 0.0002).Conclusions: The present analysis confirms the superiority of MUS over Burch colposuspension. The studies comparing insertion of RT-TVT and TO-TVT showed higher subjective and objective cure rates for the RP-TVT but at the cost of higher risks of some complications and voiding lower urinary tract symptoms. Efficacy of inside-out and outside-in techniques of TO-TVT insertion was similar, although the risk of vaginal perforation was lower in the inside-to-out TO-TVT.Patient summary: Retropubic and transobturator midurethral slings are a popular treatment for female stress urinary incontinence. The available literature suggest that those slings are either more effective or safer than other older surgical procedures. Retropubic tapes are followed with slightly higher continence rates as compared with the transobturator tapes but are associated with higher risk of intra- and postoperative complications.",
keywords = "Stress urinary incontinence, Burch colposuspension, Pubovaginal sling, Retropubic vaginal tape, Tension free tape, Transobturator tape",
author = "Ferdinando Fusco and Mohamed Abdel-Fattah and Chapple, {Christopher R.} and Massimiliano Creta and {La Falce}, Sabrina and David Waltregny and Giacomo Novara",
note = "Funding/Support and role of the sponsor: None.",
year = "2017",
month = "10",
doi = "10.1016/j.eururo.2017.04.026",
language = "English",
volume = "72",
pages = "567--591",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "4",

}

TY - JOUR

T1 - Updated Systematic Review and Meta-analysis of the Comparative Data on Colposuspensions, Pubovaginal slings, and Midurethral tapes in the Surgical Treatment of Female Stress Urinary Incontinence

AU - Fusco, Ferdinando

AU - Abdel-Fattah, Mohamed

AU - Chapple, Christopher R.

AU - Creta, Massimiliano

AU - La Falce, Sabrina

AU - Waltregny, David

AU - Novara, Giacomo

N1 - Funding/Support and role of the sponsor: None.

PY - 2017/10

Y1 - 2017/10

N2 - Context: Retropubic (RP-TVT) and transobturator miurethral (TO-TVT) midurethral sling (MUS) are popular surgical treatments for female stress urinary incontinence. The long-term efficacy and safety of the procedures is still a topic of intense clinical research and several randomised controlled trials (RCTs) have been published in the last years.Objective: To evaluate the efficacy and safety of MUS compared with other surgical treatments for female stress urinary incontinence.Evidence acquisition: A systematic review and meta-analysis of the literature was performed using the Medline, Scopus, and Web of Science databases to update our previously published analyses.Evidence synthesis: Twenty-eight RCTs were identified. In total, the meta-analyses included 15 855 patients. Patients receiving MUS had significantly higher overall (odds ratio [OR]: 0.59, p = 0.0003) and objective (OR: 0.51, p = 0.001) cure rates than those receiving Burch colposuspension. Patients undergoing MUS and pubovaginal slings had similar cure rates. Patients treated with RT-TVT had higher subjective (OR: 0.83, p = 0.03) and objective (OR: 0.82, p = 0.01) cure rates than those receiving TO-TVT. However, the latter had a lower risk of intraoperative bladder or vaginal perforation (OR: 2.4, p = 0.0002), pelvic haematoma (OR: 2.61, p = 0.002), urinary tract infections (OR: 1.31, p = 0.04) and voiding lower urinary tract symptoms (OR: 1.66, p = 0.002). Sensitivity analyses limited to RCTs with follow-up durations >60 mo demonstrated similar outcomes for RP-TVT and TO-TVT. No significant differences in efficacy were identified comparing inside-to-out and outside-to-in TO-TVT but vaginal perforations were less common with the former (OR: 0.21, p = 0.0002).Conclusions: The present analysis confirms the superiority of MUS over Burch colposuspension. The studies comparing insertion of RT-TVT and TO-TVT showed higher subjective and objective cure rates for the RP-TVT but at the cost of higher risks of some complications and voiding lower urinary tract symptoms. Efficacy of inside-out and outside-in techniques of TO-TVT insertion was similar, although the risk of vaginal perforation was lower in the inside-to-out TO-TVT.Patient summary: Retropubic and transobturator midurethral slings are a popular treatment for female stress urinary incontinence. The available literature suggest that those slings are either more effective or safer than other older surgical procedures. Retropubic tapes are followed with slightly higher continence rates as compared with the transobturator tapes but are associated with higher risk of intra- and postoperative complications.

AB - Context: Retropubic (RP-TVT) and transobturator miurethral (TO-TVT) midurethral sling (MUS) are popular surgical treatments for female stress urinary incontinence. The long-term efficacy and safety of the procedures is still a topic of intense clinical research and several randomised controlled trials (RCTs) have been published in the last years.Objective: To evaluate the efficacy and safety of MUS compared with other surgical treatments for female stress urinary incontinence.Evidence acquisition: A systematic review and meta-analysis of the literature was performed using the Medline, Scopus, and Web of Science databases to update our previously published analyses.Evidence synthesis: Twenty-eight RCTs were identified. In total, the meta-analyses included 15 855 patients. Patients receiving MUS had significantly higher overall (odds ratio [OR]: 0.59, p = 0.0003) and objective (OR: 0.51, p = 0.001) cure rates than those receiving Burch colposuspension. Patients undergoing MUS and pubovaginal slings had similar cure rates. Patients treated with RT-TVT had higher subjective (OR: 0.83, p = 0.03) and objective (OR: 0.82, p = 0.01) cure rates than those receiving TO-TVT. However, the latter had a lower risk of intraoperative bladder or vaginal perforation (OR: 2.4, p = 0.0002), pelvic haematoma (OR: 2.61, p = 0.002), urinary tract infections (OR: 1.31, p = 0.04) and voiding lower urinary tract symptoms (OR: 1.66, p = 0.002). Sensitivity analyses limited to RCTs with follow-up durations >60 mo demonstrated similar outcomes for RP-TVT and TO-TVT. No significant differences in efficacy were identified comparing inside-to-out and outside-to-in TO-TVT but vaginal perforations were less common with the former (OR: 0.21, p = 0.0002).Conclusions: The present analysis confirms the superiority of MUS over Burch colposuspension. The studies comparing insertion of RT-TVT and TO-TVT showed higher subjective and objective cure rates for the RP-TVT but at the cost of higher risks of some complications and voiding lower urinary tract symptoms. Efficacy of inside-out and outside-in techniques of TO-TVT insertion was similar, although the risk of vaginal perforation was lower in the inside-to-out TO-TVT.Patient summary: Retropubic and transobturator midurethral slings are a popular treatment for female stress urinary incontinence. The available literature suggest that those slings are either more effective or safer than other older surgical procedures. Retropubic tapes are followed with slightly higher continence rates as compared with the transobturator tapes but are associated with higher risk of intra- and postoperative complications.

KW - Stress urinary incontinence

KW - Burch colposuspension

KW - Pubovaginal sling

KW - Retropubic vaginal tape

KW - Tension free tape

KW - Transobturator tape

U2 - 10.1016/j.eururo.2017.04.026

DO - 10.1016/j.eururo.2017.04.026

M3 - Article

VL - 72

SP - 567

EP - 591

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 4

ER -