EURURO Vol. 72 No. 4

589 656

bridges a significant gap in the current literature. Taken
together, those data corroborate the findings of the previous
reports of ours with stronger results based on large number
of patients included in analyses and, above all, larger
number of studies with follow-up duration 60 mo.
However, we acknowledge a number of limitations. First,
a small percentage of the patients included in some RCTs
had already received previous surgical treatments for SUI.
However, such percentage was extremely low. Similar to
our previous reports, the evaluation of subjective and
objective outcomes was heterogeneous and not all studies
utilized validated questionnaires. Although the number of
studies with follow-up 60 mo was higher with respect to
previous meta-analysis, the short duration of the follow-up
remains a limit of available literature as most studies report
short- or intermediate-term follow-up. Limited data were
available of potentially interesting outcomes such as long-
term pain and dyspareunia. Moreover, the accuracy of
complication reporting is limited in most RCTs, not
complying with the standardised Martin criteria Final-
ly, studies comparing MUS to other surgical treatments,
such as bulking agent injections are lacking.
Overall, the literature summarised in this updated meta-
analysis confirms the superiority of MUS over BC and PVS
for the treatment of primary female SUI. MUS are
significantly more effective than BC in terms of overall
and objective continence rates. Although equivalent to PVS
in terms of overall and subjective continence rates, MUS
show a statistically significant lower incidence of storage
LUTS. The studies comparing insertion of the MUS by the
retropubic and transobturator routes showed a slightly
higher rate of objective cure rate in favour of the RP-TVT but
at the cost of higher risks of intraoperative complications
and voiding LUTS. No significant differences emerged from
comparison of inside-out and outside-in techniques of
TO-TVT insertion with regard to efficacy, although the risk
of vaginal perforation and, in a lower extent, of vaginal
erosions were more favourable in the inside-to-out TO-TVT.
The heterogeneity in outcome measures and the lack of
RCTs with long-term follow-up remain major limits of
available literature.
Author contributions: Giacomo Novara had full access to all the data in
the study and takes responsibility for the integrity of the data and the
accuracy of the data analysis.
Study concept and design: Novara, Fusco.
Acquisition of data: Novara, Fusco, Creta, La Falce.
Analysis and interpretation of data: All authors.
Drafting of the manuscript: Novara.
Critical revision of the manuscript for important intellectual content: All
authors.
Statistical analysis: Novara.
Obtaining funding: None.
Administrative, technical, or material support: None.
Supervision: Novara, Fusco.
Other: None.
Financial disclosures: Giacomo Novara certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/affiliation, grants or funding, consultancies,
honoraria, stock ownership or options, expert testimony, royalties, or
patents filed, received, or pending), are the following: Abdel-Fattah has
previously (none in the last 4 yr) delivered paid lectures and/or training
courses for Bard, Coloplast, AMS, Pfizer, and Astellas. He received travel
grants from different pharmaceutical companies to attend medical
conferences in the past. University of Aberdeen received research grant
from Coloplast in 2009; Chapple has been Scientific Study/Trial
(Researcher/Author), Meeting Participant/Lecturer, Consultant/Advisor
to Allergan, Grant, Scientific Study/Trial (Researcher/Author), Meeting
Participant/Lecturer, Consultant/Advisor to Astellas, Meeting Participant/
Lecturer to Boston, Consultant/Advisor to Medtronic; Scientific Study/
Trial (Researcher/Author), Consultant/Advisor to Recordati; Novara has
been An Advisory Board Member, Consultant, and/or Speaker to Astellas,
GlaxoSmithKleine, Lilly, Menarini, Nycomed, Pfizer Inc., Pierre Fabre, and
Recordati.
Funding/Support and role of the sponsor: None.
Appendix A. Supplementary data
Supplementary data associated with this article can be
found, in the online version, at
.
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