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Surgical treatment of recurrent stress urinary incontinence in women: a systematic review and meta-analysis of randomised controlled trials.
Eur Urol. 2013 Aug; 64(2):323-36.EU

Abstract

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.

Authors+Show Affiliations

NHS Ayrshire & Arran, NHS Research Scotland, Kilmarnock, UK. Wael.Agur@glasgow.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

23680414

Citation

Agur, Wael, et al. "Surgical Treatment of Recurrent Stress Urinary Incontinence in Women: a Systematic Review and Meta-analysis of Randomised Controlled Trials." European Urology, vol. 64, no. 2, 2013, pp. 323-36.
Agur W, Riad M, Secco S, et al. Surgical treatment of recurrent stress urinary incontinence in women: a systematic review and meta-analysis of randomised controlled trials. Eur Urol. 2013;64(2):323-36.
Agur, W., Riad, M., Secco, S., Litman, H., Madhuvrata, P., Novara, G., & Abdel-Fattah, M. (2013). Surgical treatment of recurrent stress urinary incontinence in women: a systematic review and meta-analysis of randomised controlled trials. European Urology, 64(2), 323-36. https://doi.org/10.1016/j.eururo.2013.04.034
Agur W, et al. Surgical Treatment of Recurrent Stress Urinary Incontinence in Women: a Systematic Review and Meta-analysis of Randomised Controlled Trials. Eur Urol. 2013;64(2):323-36. PubMed PMID: 23680414.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of recurrent stress urinary incontinence in women: 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, Y1 - 2013/04/26/ PY - 2013/02/19/received PY - 2013/04/16/accepted PY - 2013/5/18/entrez PY - 2013/5/18/pubmed PY - 2014/2/8/medline KW - Colposuspension KW - Complications KW - Recurrent urinary incontinence KW - Suburethral slings KW - Tension-free vaginal tape KW - Transobturator tape KW - Urodynamic stress incontinence SP - 323 EP - 36 JF - European urology JO - Eur Urol VL - 64 IS - 2 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. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/23680414/Surgical_treatment_of_recurrent_stress_urinary_incontinence_in_women:_a_systematic_review_and_meta_analysis_of_randomised_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(13)00419-3 DB - PRIME DP - Unbound Medicine ER -