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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

Meta-analysis results: (a) Patient-reported cure rate; (b) objective cure rate; (c) operative time; (d) postoperative pain; (e) lower urinary tract injuries; (f) groin pain; (g) postoperative voiding difficulties; (h) de novo urgency and/or worsening of preexisting surgery; (i) vaginal tape erosion; (j) repeat continence surgery. CI = confidence interval; M-H = Mantel-Haenszel; SIMS-Ajust = single-incision mini-sling Ajust
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Fig2: Meta-analysis results: (a) Patient-reported cure rate; (b) objective cure rate; (c) operative time; (d) postoperative pain; (e) lower urinary tract injuries; (f) groin pain; (g) postoperative voiding difficulties; (h) de novo urgency and/or worsening of preexisting surgery; (i) vaginal tape erosion; (j) repeat continence surgery. CI = confidence interval; M-H = Mantel-Haenszel; SIMS-Ajust = single-incision mini-sling Ajust

Mentions: A total of three studies were included to compare the objective cure rate of two sling surgeries: there are 235 cases in the SIMS-Ajust group, and the number of objective cure cases is 187; there are 200 cases in the TVT-O/TOT group, and the number of objective cure cases is 167. Heterogeneity test I2 = 0 %, P > 0.1, and therefore, the included literature can be considered homogeneous, and a fixed model is used for the statistical analysis. The results show that the objective cure rate of the two groups has no significant difference [RR = 0.95, 95 % CI (0.87 to 1.04), P > 0.05] (see Fig. 2a). A total of four studies were included for the comparison of the patient-reported cure rate: 261 cases in the SIMS-Ajust group with 216 patient-reported cure cases; 261 cases in the TVT-O/TOT group with 222 patient-reported cure cases. The heterogeneity test I2 = 0 %, P > 0.1, and therefore, the included reports can be considered homogeneous. A fixed model is then used for the statistical analysis, and the results show no significant difference in the patient-reported cure rate in the treatment of female stress urinary incontinence between SIMS-Ajust and TVT-O/TOT [RR = 0.97, 95 % CI (0.90 to 1.05), P > 0.05] (see Fig. 2b).Fig. 2


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)

Meta-analysis results: (a) Patient-reported cure rate; (b) objective cure rate; (c) operative time; (d) postoperative pain; (e) lower urinary tract injuries; (f) groin pain; (g) postoperative voiding difficulties; (h) de novo urgency and/or worsening of preexisting surgery; (i) vaginal tape erosion; (j) repeat continence surgery. CI = confidence interval; M-H = Mantel-Haenszel; SIMS-Ajust = single-incision mini-sling Ajust
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Meta-analysis results: (a) Patient-reported cure rate; (b) objective cure rate; (c) operative time; (d) postoperative pain; (e) lower urinary tract injuries; (f) groin pain; (g) postoperative voiding difficulties; (h) de novo urgency and/or worsening of preexisting surgery; (i) vaginal tape erosion; (j) repeat continence surgery. CI = confidence interval; M-H = Mantel-Haenszel; SIMS-Ajust = single-incision mini-sling Ajust
Mentions: A total of three studies were included to compare the objective cure rate of two sling surgeries: there are 235 cases in the SIMS-Ajust group, and the number of objective cure cases is 187; there are 200 cases in the TVT-O/TOT group, and the number of objective cure cases is 167. Heterogeneity test I2 = 0 %, P > 0.1, and therefore, the included literature can be considered homogeneous, and a fixed model is used for the statistical analysis. The results show that the objective cure rate of the two groups has no significant difference [RR = 0.95, 95 % CI (0.87 to 1.04), P > 0.05] (see Fig. 2a). A total of four studies were included for the comparison of the patient-reported cure rate: 261 cases in the SIMS-Ajust group with 216 patient-reported cure cases; 261 cases in the TVT-O/TOT group with 222 patient-reported cure cases. The heterogeneity test I2 = 0 %, P > 0.1, and therefore, the included reports can be considered homogeneous. A fixed model is then used for the statistical analysis, and the results show no significant difference in the patient-reported cure rate in the treatment of female stress urinary incontinence between SIMS-Ajust and TVT-O/TOT [RR = 0.97, 95 % CI (0.90 to 1.05), P > 0.05] (see Fig. 2b).Fig. 2

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