Long-term outcomes after mid-urethral slings for urinary incontinence: a systematic review and meta-analysis
IUGA Academy. Juliato C. Jun 30, 2018; 212906; 267 Topic: Stress Incontinence
Prof. Dr. Cassia Juliato
Prof. Dr. Cassia Juliato

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Long-term outcomes after mid-urethral slings for urinary incontinence: a systematic review and meta-analysis

Juliato, C1; Santos-Jr, L1; Gomes, T1; Ranzani, F1; Castro, E1; Araujo, C2

1: University of Campinas; 2: university of Campinas

Introduction: There is a vast literature concerning mid-urethral slings (MUS) in the treatment of female stress urinary incontinence (SUI), both retropubic (RT) and transobturator (TO), however, long-term results regarding both continence and complications are scarce (1).

Objective: Evaluate the long term evidence regarding the use of synthetic mesh for the treatment of female urinary incontinence (UI), its efficacy, satisfaction and complication rates in a longer follow-up, comparing RP and TO.

Methods: This review is registered in the PROSPERO database. The criteria for inclusion were randomized trials comparing RP versus TO slings, with a minimum 3-year follow up, for female SUI and published until December 1st, 2017.We excluded studies involving mini-slings or autologous tapes.The MeSH terms were stress urinary incontinence, suburethral sling, transobturator tape, urethral sling, midurethral sling, mid-urethral sling, tensionless vaginal tape, vaginal tape, tension-free vaginal tape and tension free vaginal tape.Initially, the articles were selected through title or summary analysis.The, full-text articles that potentially addressed the main goals were analyzed. The meta-analysis was performed for each endpoint studied.

Results: The search retrieved 1585 articles.

After analysis, 8 articles assessed in the final review included, with a medium follow up of 65.5 months.

For the objective cure analysis, considering per protocol data, 7 articles were included for meta-analysis, no statistical difference between groups at long term follow up (RR 0,98; CI 0,91-1,05).

Also, when intention-to-treat analysis was made, 6 articles were included and once more, meta-analysis showed no statistical relevance (RR 0,98 – CI 0,9-1,06).

When we compiled satisfaction, for intention-to-treat analysis, assessed for meta-analysis, with no statistical difference between groups (RR 0,97 – CI 0,9-1,05).

Considering other forms of subjective cure definitions for meta-analysis – there was no difference between groups at long term follow-up (RR 0,98 – IC 0,9-1,06).

For the complication analysis, the presence of de novo pain in the lower abdomen or groin, the meta-analysis included 2 studies, showing no difference between groups (RR 0,64 – IC 0,36-1,15).

The urinary tract symptoms led to 3 meta-analysis – postoperative urinary residual greater than 100 mL was reported in 4 studies, without significant difference (RR 0,68 - IC 0,37-1,22); postoperative urinary tract infection was seen on 3 studies, also without statistical difference between groups (RR 0,93 – IC 0,60-1,43); when it comes to de novo urinary urgency, 3 studies were included for analysis, and showed no difference (RR 0,84 – IC 0,49-1,13).

For the mesh complication analysis, we include a total of 6 studies, and the meta-analysis showed a 3-fold increase in the risk of mesh extrusion/erosion in the TO group (RR 3,21 – IC 1,48-6,96).

Many different instruments were used of Quality of life (QOL) and none of these studies individually showed statistical difference between groups using QOL validated instruments

Conclusion: Findings from this systematic review and meta-analysis suggest that the SUI treatment with RT or TO have similar objective and subjective cure rates. The complications rates are similar, despite the mesh except for the extrusion rate that are tree times more in TO technique.

1-Cochrane Database Syst Rev.2015 1;(7):CD006375.


Work supported by industry: no.

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