Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence.

Context: Burch colposuspension, pubovaginal sling, and midurethral retropubictape (RT) and transobturator tape (TOT) have been the most popular surgicaltreatments for female stress urinary incontinence (SUI). Several randomizedcontrolled trials (RCTs) have been published comparing the different techniques,with conflicting results.Objective: Our aim was to evaluate the efficacy, complication, and reoperationrates of midurethral tapes compared with other surgical treatments for female SUI.Evidence acquisition: A systematic review of the literature was performed usingthe Medline, Embase, Scopus, Web of Science databases, and Cochrane Database ofSystematic Reviews.Evidence synthesis: Thirty-nine RCTswere identified. Patients receivingmidurethraltapes had significantly higher overall (odds ratio [OR]: 0.61; confidence interval[CI]: 0.46–0.82; p = 0.00009) and objective (OR: 0.38; CI: 0.25–0.57; p < 0.0001)cure rates than those receiving Burch colposuspension, although they had a higherrisk of bladder perforations (OR: 4.94; CI: 2.09–11.68; p = 0.00003). Patientsundergoing midurethral tapes and pubovaginal slings had similar cure rates,although the latter were slightly more likely to experience storage lower urinarytract symptoms (LUTS) (OR: 0.31; CI: 0.10–0.94; p = 0.04) and had a higherreoperation rate (OR: 0.31; CI: 0.12–0.82; p = 0.02). Patients treated with RT hadslightly higher objective cure rates (OR: 0.8;CI: 0.65–0.99; p = 0.04) than thosetreated with TOT; however, subjective cure rates were similar, and patients treatedwith TOT had a much lower risk of bladder and vaginal perforations (OR: 2.5;CI: 1.75–3.57; p < 0.00001), hematoma (OR: 2.62; CI: 1.35–5.08; p = 0.005), andstorage LUTS (OR: 1.35; CI: 1.05–1.72; p = 0.02).Meta-analysis demonstrated similaroutcomes for TVT-O (University of Lie`ge, Lie`ge, Wallonia, Belgium) and Monarc(AMS, Minnetonka, MN, USA).Conclusions: Patients treated with RT experienced slightly higher continence ratesthan those treated with Burch colposuspension, but they faced amuch higher risk ofintraoperative complications. RT and pubovaginal slings were similarly effective,although patients with pubovaginal slings were more likely to experience storageLUTS. The use of RT was followed by objective cure rates slightly higher than TOT,but subjective cure rates were similar. TOT had a lower risk of bladder and vaginalperforations and storage LUTS than RT. The strength of these findings is limited bythe heterogeneity of the outcome measures and the short length of follow-up.