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Platinum Priority – Review – Female Urology – Incontinence
Editorial by Frank Van der Aa, Jan Deprest and Dirk De Ridder on pp. 592–593 of this issue
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
a ,Mohamed Abdel-Fattah
b ,Christopher R. Chapple
c ,Massimiliano Creta
d ,Sabrina La Falce
e ,David Waltregny
f ,Giacomo Novara
e , *a
Urology Unit, Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy;
b
Division of
Applied Health Sciences, University of Aberdeen, Second Floor, Aberdeen Maternity Hospital, Foresterhill, Aberdeen, UK;
c
Department of Urology Research,
University of Sheffield, Sheffield, England, UK;
d
Urology Unit, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy;
e
Department of Surgery, Oncology, and
Gastroenterology, Urology Clinic, University of Padua, Padua, Italy;
f
Department of Urology, University Hospital of Lie`ge, Lie`ge, Belgium
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 5 6 7 – 5 9 1ava ilable at
www.sciencedirect.comjournal homepage:
www.eu ropeanurology.comArticle info
Article history:
Accepted April 19, 2017
Associate Editor:
Christian Gratzke
Keywords:
Stress urinary incontinence
Burch colposuspension
Pubovaginal sling
Stress urinary incontinence
Retropubic vaginal tape
Tension free tape
Transobturator tape
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). Sensitivi-
ty 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 colpo-
suspension. 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
* Corresponding author. Department of Surgery, Oncology, and Gastroenterology, Urology Clinic,
University of Padua, Monoblocco Ospedaliero, IV Floor Via Giustiniani 2, Padua 35128, Italy.
Tel. +39 049 8211250; Fax: +39 049 8218757.
E-mail addresses:
giacomonovara@gmail.com,
giacomo.novara@unipd.it(G. Novara).
http://dx.doi.org/10.1016/j.eururo.2017.04.0260302-2838/
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2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.