INTRODUCTION AND HYPOTHESIS: Questions regarding the long-term efficacy and safety of midurethral slings (MUS) are still unresolved, notwithstanding the widespread use of these procedures.
The objective of this review was to evaluate the long-term outcomes of retropubic MUS (RP-MUS) procedures and the medium-term outcomes of transobturator MUS (TO-MUS) procedures.
METHODS: MEDLINE, EMBASE, NLH, ClinicalTrials.gov, and Google Scholar databases were searched up to June 2014 with restriction to English language and using the search terms: "stress urinary incontinence", "midurethral sling", "tension-free tape", "transobturator tape", and "follow-up". Studies with a follow-up of 36 months for TO-MUS and 60 months for RP-MUS were searched. Only studies comparing a RP-MUS or TO-MUS with another synthetic sling were included. Data from 49 studies were included. Data were expressed as odds ratios (OR) with 95 % confidence intervals (CI) and combined using the Mantel-Haenszel fixed effects model. Differences in the proportions were evaluated using the chi-squared test.
RESULTS: RP-MUS had similar objective cure rates (OR 1.15, 95 % CI 0.75 - 1.76) but higher subjective cure rates than TO-MUS (OR 1.76, 95 % CI 1.08 - 2.86). No differences were observed between outside-in (TOT) and inside-out (TVT-O) and between TO-MUS and minisling. Bladder injuries were more frequent (OR 7.01, 95 % CI 2.94 - 17.90) and vaginal erosions were less frequent for RP-MUS (OR 0.24, 95 % CI 0.07 - 0.84). Vaginal injuries were more common with TOT than with TVT-O (OR 7.96, 95 % CI 1.15 - 157.9). Pain-related complications were more common with TO-MUS than with minimally invasive tapes (OR 8.75; 95 % CI 9.02 - 57.90).
CONCLUSIONS: MUS have similar objective cure rates in the long term and medium term. TO-MUS is associated with a lower subjective cure rate than RP-MUS.
Written by:
Tommaselli GA, Di Carlo C, Formisano C, Fabozzi A, Nappi C. Are you the author?
Department of Obstetrics and Gynecology, University of Naples "Federico II", Via S. Pansini, 5, Naples, 80131, Italy.
Reference: Int Urogynecol J. 2015 May 20. Epub ahead of print.
doi: 10.1007/s00192-015-2645-5
PubMed Abstract
PMID: 25990203