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Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis.
Am J Obstet Gynecol. 2014 Jul; 211(1):71.e1-71.e27.AJ

Abstract

OBJECTIVE

Understanding the long-term comparative effectiveness of competing surgical repairs is essential as failures after primary interventions for stress urinary incontinence (SUI) may result in a third of women requiring repeat surgery.

STUDY DESIGN

We conducted a systematic review including English-language randomized controlled trials from 1990 through April 2013 with a minimum 12 months of follow-up comparing a sling procedure for SUI to another sling or Burch urethropexy. When at least 3 randomized controlled trials compared the same surgeries for the same outcome, we performed random effects model metaanalyses to estimate pooled odds ratios (ORs).

RESULTS

For midurethral slings (MUS) vs Burch, metaanalysis of objective cure showed no significant difference (OR, 1.18; 95% confidence interval [CI], 0.73-1.89). Therefore, we suggest either intervention; the decision should balance potential adverse events (AEs) and concomitant surgeries. For women considering pubovaginal sling vs Burch, the evidence favored slings for both subjective and objective cure. We recommend pubovaginal sling to maximize cure outcomes. For pubovaginal slings vs MUS, metaanalysis of subjective cure favored MUS (OR, 0.40; 95% CI, 0.18-0.85). Therefore, we recommend MUS. For obturator slings vs retropubic MUS, metaanalyses for both objective (OR, 1.16; 95% CI, 0.93-1.45) and subjective cure (OR, 1.17; 95% CI, 0.91-1.51) favored retropubic slings but were not significant. Metaanalysis of satisfaction outcomes favored obturator slings but was not significant (OR, 0.77; 95% CI, 0.52-1.13). AEs were variable between slings; metaanalysis showed overactive bladder symptoms were more common following retropubic slings (OR, 1.413; 95% CI, 1.01-1.98, P = .046). We recommend either retropubic or obturator slings for cure outcomes; the decision should balance AEs. For minislings vs full-length MUS, metaanalyses of objective (OR, 4.16; 95% CI, 2.15-8.05) and subjective (OR, 2.65; 95% CI, 1.36-5.17) cure both significantly favored full-length slings. Therefore, we recommend a full-length MUS.

CONCLUSION

Surgical procedures for SUI differ for success rates and complications, and both should be incorporated into surgical decision-making. Low- to high-quality evidence permitted mostly level-1 recommendations when guidelines were possible.

Authors+Show Affiliations

Division of Gynecology and Urogynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI. Electronic address: mschimpf@umich.edu.Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville, Greenville, SC.Department of Obstetrics and Gynecology, Kaiser Permanente, Roseville, CA.Department of Obstetrics and Gynecology, University of Texas Southwestern at Seton Healthcare Family, Austin, TX.Department of Obstetrics and Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, TX.Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.Division of Urogynecology, Department of Obstetrics and Gynecology, Kaiser Permanente, Oakland, CA.Division of Urogynecology, Department of Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA.Department of Urogynecology, ProHealth Care, Women's Center, Medical College of Wisconsin, Waukesha, WI.Icahn School of Medicine at Mount Sinai, Department of Obstetrics and Gynecology, New York, NY.Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, Nashville, TN.Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA.Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, RI.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

24487005

Citation

Schimpf, Megan O., et al. "Sling Surgery for Stress Urinary Incontinence in Women: a Systematic Review and Metaanalysis." American Journal of Obstetrics and Gynecology, vol. 211, no. 1, 2014, pp. 71.e1-71.e27.
Schimpf MO, Rahn DD, Wheeler TL, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211(1):71.e1-71.e27.
Schimpf, M. O., Rahn, D. D., Wheeler, T. L., Patel, M., White, A. B., Orejuela, F. J., El-Nashar, S. A., Margulies, R. U., Gleason, J. L., Aschkenazi, S. O., Mamik, M. M., Ward, R. M., Balk, E. M., & Sung, V. W. (2014). Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. American Journal of Obstetrics and Gynecology, 211(1), e1-e27. https://doi.org/10.1016/j.ajog.2014.01.030
Schimpf MO, et al. Sling Surgery for Stress Urinary Incontinence in Women: a Systematic Review and Metaanalysis. Am J Obstet Gynecol. 2014;211(1):71.e1-71.e27. PubMed PMID: 24487005.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. AU - Schimpf,Megan O, AU - Rahn,David D, AU - Wheeler,Thomas L, AU - Patel,Minita, AU - White,Amanda B, AU - Orejuela,Francisco J, AU - El-Nashar,Sherif A, AU - Margulies,Rebecca U, AU - Gleason,Jonathan L, AU - Aschkenazi,Sarit O, AU - Mamik,Mamta M, AU - Ward,Renée M, AU - Balk,Ethan M, AU - Sung,Vivian W, AU - ,, Y1 - 2014/01/30/ PY - 2013/08/26/received PY - 2013/11/22/revised PY - 2014/01/21/accepted PY - 2014/2/4/entrez PY - 2014/2/4/pubmed PY - 2014/8/26/medline KW - Burch urethropexy KW - midurethral sling KW - pubovaginal sling KW - single-incision sling KW - stress urinary incontinence SP - 71.e1 EP - 71.e27 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 211 IS - 1 N2 - OBJECTIVE: Understanding the long-term comparative effectiveness of competing surgical repairs is essential as failures after primary interventions for stress urinary incontinence (SUI) may result in a third of women requiring repeat surgery. STUDY DESIGN: We conducted a systematic review including English-language randomized controlled trials from 1990 through April 2013 with a minimum 12 months of follow-up comparing a sling procedure for SUI to another sling or Burch urethropexy. When at least 3 randomized controlled trials compared the same surgeries for the same outcome, we performed random effects model metaanalyses to estimate pooled odds ratios (ORs). RESULTS: For midurethral slings (MUS) vs Burch, metaanalysis of objective cure showed no significant difference (OR, 1.18; 95% confidence interval [CI], 0.73-1.89). Therefore, we suggest either intervention; the decision should balance potential adverse events (AEs) and concomitant surgeries. For women considering pubovaginal sling vs Burch, the evidence favored slings for both subjective and objective cure. We recommend pubovaginal sling to maximize cure outcomes. For pubovaginal slings vs MUS, metaanalysis of subjective cure favored MUS (OR, 0.40; 95% CI, 0.18-0.85). Therefore, we recommend MUS. For obturator slings vs retropubic MUS, metaanalyses for both objective (OR, 1.16; 95% CI, 0.93-1.45) and subjective cure (OR, 1.17; 95% CI, 0.91-1.51) favored retropubic slings but were not significant. Metaanalysis of satisfaction outcomes favored obturator slings but was not significant (OR, 0.77; 95% CI, 0.52-1.13). AEs were variable between slings; metaanalysis showed overactive bladder symptoms were more common following retropubic slings (OR, 1.413; 95% CI, 1.01-1.98, P = .046). We recommend either retropubic or obturator slings for cure outcomes; the decision should balance AEs. For minislings vs full-length MUS, metaanalyses of objective (OR, 4.16; 95% CI, 2.15-8.05) and subjective (OR, 2.65; 95% CI, 1.36-5.17) cure both significantly favored full-length slings. Therefore, we recommend a full-length MUS. CONCLUSION: Surgical procedures for SUI differ for success rates and complications, and both should be incorporated into surgical decision-making. Low- to high-quality evidence permitted mostly level-1 recommendations when guidelines were possible. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/24487005/Sling_surgery_for_stress_urinary_incontinence_in_women:_a_systematic_review_and_metaanalysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(14)00059-3 DB - PRIME DP - Unbound Medicine ER -