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Meta-analysis of female stress urinary incontinence treatments with adjustable single-incision mini-slings and transobturator tension-free vaginal tape surgeries.

Zhang P, Fan B, Zhang P, Han H, Xu Y, Wang B, Zhang X - BMC Urol (2015)

Bottom Line: In this paper, we systematically evaluate the relevant data on SIMS-Ajust and TVT-O/TOT and further confirm their safety and effectiveness, providing reliable clinical evidence.SIMS-Ajust is safe and effective in the treatment of female stress urinary incontinence.Its long-term efficacy needs further observation.

View Article: PubMed Central - PubMed

Affiliation: Urology department, Beijing Chaoyang hospital, Capital Medical University, 8 Gongren Tiyuchang NanluChaoyang District, Beijing, 100020, China. syfanbh@126.com.

ABSTRACT

Background: The study on SIMS and SMUS as a whole by Alyaa Mostafa et al showed that after excluding the TVT-S sling, there is no significant difference in patient-reported cure rate and objective cure rate between these two methods. In this paper, we systematically evaluate the relevant data on SIMS-Ajust and TVT-O/TOT and further confirm their safety and effectiveness, providing reliable clinical evidence.

Methods: By searching the Medline, Embase, Scopus, and Web of Science databases and the Cochrane Database of Systematic Reviews combined with manual searches, all reports on randomized controlled trials (RCTs) of single-incision mini-sling (SIMS-Ajust) and transobturator tension-free vaginal tape (TVT-O/TOT) surgeries were collected. Using RevMan 5.2 statistical software, the patient-reported cure rate, objective cure rate, operative time, postoperative pain, lower urinary tract injuries, groin pain, postoperative voiding difficulties, de novo urgency and/or worsening of preexisting surgery, vaginal tape erosion, repeated continence surgery, and other related data on both surgical methods were evaluated.

Results: A total of 154 relevant research reports were retrieved, and five randomized controlled trials were included in this study, involving a total of 678 patients. The meta-analysis results show no significant difference in the patient-reported cure rate and objective cure rate between SIMS-Ajust and TVT-O/TOT [RR = 0.95, 95% CI (0.87 to 1.04), P > 0.05; RR = 0.97, 95% CI (0.90-1.05), P > 0.05]. With respect to operation time and groin pain, SIMS-Ajust outperforms TVT-O/TOT [MD = -1.61, 95% CI (-2.48 to 0.74), P < 0.05; RR = 0.30, 95% CI (0.11 to 0.85), P < 0.05]. In terms of postoperative pain, lower urinary tract injuries, postoperative voiding difficulties, de novo urgency and/or worsening of preexisting surgery, vaginal tape erosion, and repetition of continence surgery, there is no significant difference between SIMS-Ajust and TVT-O/TOT [RR = 0.50, 95% CI(0.18-1.43), P > 0.05; RR = 2.82, 95% CI(0.14-57.76), P > 0.05; RR = 0.64, 95% CI(0.28-1.45), P > 0.05; RR = 1.06, 95% CI(0.66-1.71), P > 0.05; RR = 1.04, 95% CI(0.24-4.45), P > 0.05; RR = 1.64, 95% CI(0.41-6.61), P > 0.05].

Conclusions: SIMS-Ajust is safe and effective in the treatment of female stress urinary incontinence. Compared with TVT-O/TOT surgery, SIMS-Ajust surgery has the same high objective cure rate and patient-reported cure rate and low incidence of perioperative complications, in addition to its short operative time and low incidence of groin pain. Its long-term efficacy needs further observation.

No MeSH data available.


Related in: MedlinePlus

Preferred reporting items for systematic reviews and meta-analysis
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Related In: Results  -  Collection

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Fig1: Preferred reporting items for systematic reviews and meta-analysis

Mentions: RevMan v.5.2 (Cochrane Collaboration, Oxford UK) was used to perform meta-analysis on the included papers. Figure 1 shows the literature search process. Clinical examination and related urodynamic examination results were used to determine whether diagnosed female stress urinary incontinence patients had complications of overactive bladder, urge incontinence, and pelvic organ prolapse. We collected information about cure rate, operation time, and postoperative complications, including postoperative pain, lower urinary tract injuries, groin pain, postoperative voiding difficulties, de novo urgency and or worsening of preexisting surgery, vaginal tape erosion, and repeated continence surgery, and we analyzed the effectiveness and safety on this basis. The mean difference (MD) for quantitative data and relative risk (RR) for qualitative data were used as statistical values for efficacy analysis; the interval estimation used 95 % as the confidence interval [12]. The Q test was used to test the heterogeneity of the included studies. When the heterogeneity difference of each test had no statistical significance (P > 0.10, I2 < 50 %), a fixed effects model was used for meta-analysis; when the heterogeneity difference of a test had statistical significance (P < 0.10, I2 > 50 %), the reasons for heterogeneity were analyzed, and subgroup analysis was performed. A forest plot was generated with the aid of software; if the included number of studies was too low (n < 10), a funnel plot was not drawn [12].Fig. 1


Meta-analysis of female stress urinary incontinence treatments with adjustable single-incision mini-slings and transobturator tension-free vaginal tape surgeries.

Zhang P, Fan B, Zhang P, Han H, Xu Y, Wang B, Zhang X - BMC Urol (2015)

Preferred reporting items for systematic reviews and meta-analysis
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4492097&req=5

Fig1: Preferred reporting items for systematic reviews and meta-analysis
Mentions: RevMan v.5.2 (Cochrane Collaboration, Oxford UK) was used to perform meta-analysis on the included papers. Figure 1 shows the literature search process. Clinical examination and related urodynamic examination results were used to determine whether diagnosed female stress urinary incontinence patients had complications of overactive bladder, urge incontinence, and pelvic organ prolapse. We collected information about cure rate, operation time, and postoperative complications, including postoperative pain, lower urinary tract injuries, groin pain, postoperative voiding difficulties, de novo urgency and or worsening of preexisting surgery, vaginal tape erosion, and repeated continence surgery, and we analyzed the effectiveness and safety on this basis. The mean difference (MD) for quantitative data and relative risk (RR) for qualitative data were used as statistical values for efficacy analysis; the interval estimation used 95 % as the confidence interval [12]. The Q test was used to test the heterogeneity of the included studies. When the heterogeneity difference of each test had no statistical significance (P > 0.10, I2 < 50 %), a fixed effects model was used for meta-analysis; when the heterogeneity difference of a test had statistical significance (P < 0.10, I2 > 50 %), the reasons for heterogeneity were analyzed, and subgroup analysis was performed. A forest plot was generated with the aid of software; if the included number of studies was too low (n < 10), a funnel plot was not drawn [12].Fig. 1

Bottom Line: In this paper, we systematically evaluate the relevant data on SIMS-Ajust and TVT-O/TOT and further confirm their safety and effectiveness, providing reliable clinical evidence.SIMS-Ajust is safe and effective in the treatment of female stress urinary incontinence.Its long-term efficacy needs further observation.

View Article: PubMed Central - PubMed

Affiliation: Urology department, Beijing Chaoyang hospital, Capital Medical University, 8 Gongren Tiyuchang NanluChaoyang District, Beijing, 100020, China. syfanbh@126.com.

ABSTRACT

Background: The study on SIMS and SMUS as a whole by Alyaa Mostafa et al showed that after excluding the TVT-S sling, there is no significant difference in patient-reported cure rate and objective cure rate between these two methods. In this paper, we systematically evaluate the relevant data on SIMS-Ajust and TVT-O/TOT and further confirm their safety and effectiveness, providing reliable clinical evidence.

Methods: By searching the Medline, Embase, Scopus, and Web of Science databases and the Cochrane Database of Systematic Reviews combined with manual searches, all reports on randomized controlled trials (RCTs) of single-incision mini-sling (SIMS-Ajust) and transobturator tension-free vaginal tape (TVT-O/TOT) surgeries were collected. Using RevMan 5.2 statistical software, the patient-reported cure rate, objective cure rate, operative time, postoperative pain, lower urinary tract injuries, groin pain, postoperative voiding difficulties, de novo urgency and/or worsening of preexisting surgery, vaginal tape erosion, repeated continence surgery, and other related data on both surgical methods were evaluated.

Results: A total of 154 relevant research reports were retrieved, and five randomized controlled trials were included in this study, involving a total of 678 patients. The meta-analysis results show no significant difference in the patient-reported cure rate and objective cure rate between SIMS-Ajust and TVT-O/TOT [RR = 0.95, 95% CI (0.87 to 1.04), P > 0.05; RR = 0.97, 95% CI (0.90-1.05), P > 0.05]. With respect to operation time and groin pain, SIMS-Ajust outperforms TVT-O/TOT [MD = -1.61, 95% CI (-2.48 to 0.74), P < 0.05; RR = 0.30, 95% CI (0.11 to 0.85), P < 0.05]. In terms of postoperative pain, lower urinary tract injuries, postoperative voiding difficulties, de novo urgency and/or worsening of preexisting surgery, vaginal tape erosion, and repetition of continence surgery, there is no significant difference between SIMS-Ajust and TVT-O/TOT [RR = 0.50, 95% CI(0.18-1.43), P > 0.05; RR = 2.82, 95% CI(0.14-57.76), P > 0.05; RR = 0.64, 95% CI(0.28-1.45), P > 0.05; RR = 1.06, 95% CI(0.66-1.71), P > 0.05; RR = 1.04, 95% CI(0.24-4.45), P > 0.05; RR = 1.64, 95% CI(0.41-6.61), P > 0.05].

Conclusions: SIMS-Ajust is safe and effective in the treatment of female stress urinary incontinence. Compared with TVT-O/TOT surgery, SIMS-Ajust surgery has the same high objective cure rate and patient-reported cure rate and low incidence of perioperative complications, in addition to its short operative time and low incidence of groin pain. Its long-term efficacy needs further observation.

No MeSH data available.


Related in: MedlinePlus