PMID- 24487005 OWN - NLM STAT- MEDLINE DCOM- 20140825 LR - 20220331 IS - 1097-6868 (Electronic) IS - 0002-9378 (Linking) VI - 211 IP - 1 DP - 2014 Jul TI - Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. PG - 71.e1-71.e27 LID - S0002-9378(14)00059-3 [pii] LID - 10.1016/j.ajog.2014.01.030 [doi] AB - OBJECTIVE: Understanding the long-term comparative effectiveness of competing surgical repairs is essential as failures after primary interventions for stress urinary incontinence (SUI) may result in a third of women requiring repeat surgery. STUDY DESIGN: We conducted a systematic review including English-language randomized controlled trials from 1990 through April 2013 with a minimum 12 months of follow-up comparing a sling procedure for SUI to another sling or Burch urethropexy. When at least 3 randomized controlled trials compared the same surgeries for the same outcome, we performed random effects model metaanalyses to estimate pooled odds ratios (ORs). RESULTS: For midurethral slings (MUS) vs Burch, metaanalysis of objective cure showed no significant difference (OR, 1.18; 95% confidence interval [CI], 0.73-1.89). Therefore, we suggest either intervention; the decision should balance potential adverse events (AEs) and concomitant surgeries. For women considering pubovaginal sling vs Burch, the evidence favored slings for both subjective and objective cure. We recommend pubovaginal sling to maximize cure outcomes. For pubovaginal slings vs MUS, metaanalysis of subjective cure favored MUS (OR, 0.40; 95% CI, 0.18-0.85). Therefore, we recommend MUS. For obturator slings vs retropubic MUS, metaanalyses for both objective (OR, 1.16; 95% CI, 0.93-1.45) and subjective cure (OR, 1.17; 95% CI, 0.91-1.51) favored retropubic slings but were not significant. Metaanalysis of satisfaction outcomes favored obturator slings but was not significant (OR, 0.77; 95% CI, 0.52-1.13). AEs were variable between slings; metaanalysis showed overactive bladder symptoms were more common following retropubic slings (OR, 1.413; 95% CI, 1.01-1.98, P = .046). We recommend either retropubic or obturator slings for cure outcomes; the decision should balance AEs. For minislings vs full-length MUS, metaanalyses of objective (OR, 4.16; 95% CI, 2.15-8.05) and subjective (OR, 2.65; 95% CI, 1.36-5.17) cure both significantly favored full-length slings. Therefore, we recommend a full-length MUS. CONCLUSION: Surgical procedures for SUI differ for success rates and complications, and both should be incorporated into surgical decision-making. Low- to high-quality evidence permitted mostly level-1 recommendations when guidelines were possible. CI - Copyright (c) 2014 Mosby, Inc. All rights reserved. FAU - Schimpf, Megan O AU - Schimpf MO AD - Division of Gynecology and Urogynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI. Electronic address: mschimpf@umich.edu. FAU - Rahn, David D AU - Rahn DD AD - Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX. FAU - Wheeler, Thomas L AU - Wheeler TL AD - Department of Obstetrics and Gynecology, University of South Carolina School of Medicine Greenville, Greenville, SC. FAU - Patel, Minita AU - Patel M AD - Department of Obstetrics and Gynecology, Kaiser Permanente, Roseville, CA. FAU - White, Amanda B AU - White AB AD - Department of Obstetrics and Gynecology, University of Texas Southwestern at Seton Healthcare Family, Austin, TX. FAU - Orejuela, Francisco J AU - Orejuela FJ AD - Department of Obstetrics and Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, TX. FAU - El-Nashar, Sherif A AU - El-Nashar SA AD - Division of Gynecologic Surgery, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN. FAU - Margulies, Rebecca U AU - Margulies RU AD - Division of Urogynecology, Department of Obstetrics and Gynecology, Kaiser Permanente, Oakland, CA. FAU - Gleason, Jonathan L AU - Gleason JL AD - Division of Urogynecology, Department of Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA. FAU - Aschkenazi, Sarit O AU - Aschkenazi SO AD - Department of Urogynecology, ProHealth Care, Women's Center, Medical College of Wisconsin, Waukesha, WI. FAU - Mamik, Mamta M AU - Mamik MM AD - Icahn School of Medicine at Mount Sinai, Department of Obstetrics and Gynecology, New York, NY. FAU - Ward, Renee M AU - Ward RM AD - Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, Nashville, TN. FAU - Balk, Ethan M AU - Balk EM AD - Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA. FAU - Sung, Vivian W AU - Sung VW AD - Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island and Warren Alpert Medical School of Brown University, Providence, RI. CN - Society of Gynecologic Surgeons Systematic Review Group LA - eng PT - Comparative Study PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20140130 PL - United States TA - Am J Obstet Gynecol JT - American journal of obstetrics and gynecology JID - 0370476 SB - IM MH - Female MH - Humans MH - Models, Statistical MH - Odds Ratio MH - Randomized Controlled Trials as Topic MH - *Suburethral Slings MH - Treatment Outcome MH - Urethra/*surgery MH - Urinary Incontinence, Stress/*surgery OTO - NOTNLM OT - Burch urethropexy OT - midurethral sling OT - pubovaginal sling OT - single-incision sling OT - stress urinary incontinence EDAT- 2014/02/04 06:00 MHDA- 2014/08/26 06:00 CRDT- 2014/02/04 06:00 PHST- 2013/08/26 00:00 [received] PHST- 2013/11/22 00:00 [revised] PHST- 2014/01/21 00:00 [accepted] PHST- 2014/02/04 06:00 [entrez] PHST- 2014/02/04 06:00 [pubmed] PHST- 2014/08/26 06:00 [medline] AID - S0002-9378(14)00059-3 [pii] AID - 10.1016/j.ajog.2014.01.030 [doi] PST - ppublish SO - Am J Obstet Gynecol. 2014 Jul;211(1):71.e1-71.e27. doi: 10.1016/j.ajog.2014.01.030. Epub 2014 Jan 30.