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The efficacy and safety comparison of surgical treatments for stress urinary incontinence: A network meta-analysis.
Neurourol Urodyn. 2018 04; 37(4):1199-1211.NU

Abstract

AIMS

Stress urinary incontinence (SUI) is a common problem worldwide. Mainstream surgical procedures include tension-free vaginal tape (TVT), transobturator tape (TOT), tension-free vaginal tape-obturator (TVT-O), tension-free vaginal tape SECUR (TVT-S), and adjustable single-incision sling (Ajust). The aim of this study was to compare the efficacy and safety of these surgical procedures and assess which surgery is most optimal for SUI by adopting a network meta-analysis (NMA).

METHODS

Electronic databases including PubMed, Cochrance Library, and Embase database were researched systematically, until March 21, 2017. The randomized controlled trials (RCTs) that compared the efficacy and safety of TVT, TOT, TVT-O, TVT-S, and Ajust were identified. The studies were included in the analysis when met the predefined inclusion criteria. After demographic and outcome data extraction, a network meta-analysis was conducted with software R 3.3.2 and STATA 14.0. Objective cure rate, subjective cure rate, postoperative complication rate, bladder perforation, tape erosion, urinary retention, and postoperative pain were considered as outcomes, and the outcomes were displayed as odds ratios (ORs) and 95% credible intervals (CrI). The consistency of direct and indirect evidence was assessed by node splitting. The ranks based on probabilities of intervention for the different endpoints were performed.

RESULTS

Fourty-five RCTs with 7295 participants were analyzed. The NMA results revealed that, TVT, TOT, and Ajust had a higher objective cure rate than TVT-O and TVT-S (TVT-O: OR = 0.76, 95%CI [0.61, 0.94]; TVT-S: OR = 0.41, 95%CI [0.28, 0.60]). TVT, TOT, and TVT-O had a superior subjective cure rate than TVT-S and Ajust (Ajust: OR = 0.45, 95%CI [0.20, 0.91]; TVT-S: OR = 0.29, 95%CI [0.15, 0.56]). With TVT as the reference, TVT-S had a statistically lower postoperative complication rate (TVT-S: OR = 0.39, 95%CI [0.16, 0.89]). TVT-O, TVT-S, and TOT had a significantly lower bladder perforation rate (TOT: OR = 0.076, 95%CI [0.0060, 0.37]; TVT-O: OR = 4.1e-17, 95%CI [6.1e-48, 0.0032]; TVT-S: OR = 3.8e-17, 95%CI [1.8e-48, 0.0052]). There were no obvious differences between the five treatments for tape erosion. TVT-O exhibited a less postoperative retention (TVT-O: OR = 0.35, 95%CI [0.16, 0.74]). Probabilities of ranking results indicated that TOT was the treatment with best ranking in efficacy and a relatively high safety.

CONCLUSIONS

Our study recommend TOT as the optimal regimen for SUI with high efficacy and moderate safety when compared with TVT, TVT-O, TVT-S, and Ajust interventions. However, with the limitation of our study, additional high-quality studies are needed to further evaluate the outcomes.

Authors+Show Affiliations

Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.Department of Digestion, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.The College of Traditional Chinese Medicine of Jinan University, Institute of Integrated Traditional Chinese and Western Medicine of Jinan University, Guangzhou, Guangdong Province, China.Department of Radiotherapy, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China.Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

29331033

Citation

Song, Pan, et al. "The Efficacy and Safety Comparison of Surgical Treatments for Stress Urinary Incontinence: a Network Meta-analysis." Neurourology and Urodynamics, vol. 37, no. 4, 2018, pp. 1199-1211.
Song P, Wen Y, Huang C, et al. The efficacy and safety comparison of surgical treatments for stress urinary incontinence: A network meta-analysis. Neurourol Urodyn. 2018;37(4):1199-1211.
Song, P., Wen, Y., Huang, C., Wang, W., Yuan, N., Lu, Y., Wang, Q., Zhang, T., & Wen, J. (2018). The efficacy and safety comparison of surgical treatments for stress urinary incontinence: A network meta-analysis. Neurourology and Urodynamics, 37(4), 1199-1211. https://doi.org/10.1002/nau.23468
Song P, et al. The Efficacy and Safety Comparison of Surgical Treatments for Stress Urinary Incontinence: a Network Meta-analysis. Neurourol Urodyn. 2018;37(4):1199-1211. PubMed PMID: 29331033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The efficacy and safety comparison of surgical treatments for stress urinary incontinence: A network meta-analysis. AU - Song,Pan, AU - Wen,Yibo, AU - Huang,Chuiguo, AU - Wang,Wancong, AU - Yuan,Naijun, AU - Lu,Yinliang, AU - Wang,Qingwei, AU - Zhang,Tao, AU - Wen,Jianguo, Y1 - 2018/01/13/ PY - 2017/07/18/received PY - 2017/11/14/accepted PY - 2018/1/14/pubmed PY - 2019/10/1/medline PY - 2018/1/14/entrez KW - Ajust KW - TOT KW - TVT KW - TVT-O KW - TVT-S KW - network meta-analysis KW - stress urinary incontinence KW - surgical treatments SP - 1199 EP - 1211 JF - Neurourology and urodynamics JO - Neurourol Urodyn VL - 37 IS - 4 N2 - AIMS: Stress urinary incontinence (SUI) is a common problem worldwide. Mainstream surgical procedures include tension-free vaginal tape (TVT), transobturator tape (TOT), tension-free vaginal tape-obturator (TVT-O), tension-free vaginal tape SECUR (TVT-S), and adjustable single-incision sling (Ajust). The aim of this study was to compare the efficacy and safety of these surgical procedures and assess which surgery is most optimal for SUI by adopting a network meta-analysis (NMA). METHODS: Electronic databases including PubMed, Cochrance Library, and Embase database were researched systematically, until March 21, 2017. The randomized controlled trials (RCTs) that compared the efficacy and safety of TVT, TOT, TVT-O, TVT-S, and Ajust were identified. The studies were included in the analysis when met the predefined inclusion criteria. After demographic and outcome data extraction, a network meta-analysis was conducted with software R 3.3.2 and STATA 14.0. Objective cure rate, subjective cure rate, postoperative complication rate, bladder perforation, tape erosion, urinary retention, and postoperative pain were considered as outcomes, and the outcomes were displayed as odds ratios (ORs) and 95% credible intervals (CrI). The consistency of direct and indirect evidence was assessed by node splitting. The ranks based on probabilities of intervention for the different endpoints were performed. RESULTS: Fourty-five RCTs with 7295 participants were analyzed. The NMA results revealed that, TVT, TOT, and Ajust had a higher objective cure rate than TVT-O and TVT-S (TVT-O: OR = 0.76, 95%CI [0.61, 0.94]; TVT-S: OR = 0.41, 95%CI [0.28, 0.60]). TVT, TOT, and TVT-O had a superior subjective cure rate than TVT-S and Ajust (Ajust: OR = 0.45, 95%CI [0.20, 0.91]; TVT-S: OR = 0.29, 95%CI [0.15, 0.56]). With TVT as the reference, TVT-S had a statistically lower postoperative complication rate (TVT-S: OR = 0.39, 95%CI [0.16, 0.89]). TVT-O, TVT-S, and TOT had a significantly lower bladder perforation rate (TOT: OR = 0.076, 95%CI [0.0060, 0.37]; TVT-O: OR = 4.1e-17, 95%CI [6.1e-48, 0.0032]; TVT-S: OR = 3.8e-17, 95%CI [1.8e-48, 0.0052]). There were no obvious differences between the five treatments for tape erosion. TVT-O exhibited a less postoperative retention (TVT-O: OR = 0.35, 95%CI [0.16, 0.74]). Probabilities of ranking results indicated that TOT was the treatment with best ranking in efficacy and a relatively high safety. CONCLUSIONS: Our study recommend TOT as the optimal regimen for SUI with high efficacy and moderate safety when compared with TVT, TVT-O, TVT-S, and Ajust interventions. However, with the limitation of our study, additional high-quality studies are needed to further evaluate the outcomes. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/29331033/The_efficacy_and_safety_comparison_of_surgical_treatments_for_stress_urinary_incontinence:_A_network_meta_analysis_ L2 - https://doi.org/10.1002/nau.23468 DB - PRIME DP - Unbound Medicine ER -