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Clinical outcome of single‐incision slings, excluding TVT ‐Secur, vs standard slings in the surgical management of stress incontinence: an updated systematic review and meta‐analysis
Author(s) -
Kim Aram,
Kim Min Seo,
Park YoungJin,
Choi Woo Suk,
Park Hyoung Keun,
Paick Sung Hyun,
Choo MyungSoo,
Kim Hyeong Gon
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14447
Subject(s) - medicine , randomized controlled trial , surgery , meta analysis , urinary incontinence , confidence interval , systematic review , odds ratio , medline , political science , law
The aim of the present paper was to assess and compare the long‐term efficacy and safety of single‐incision mini‐slings ( SIMS s), except tension‐free vaginal tape ( TVT )‐Secur, with standard midurethral slings ( SMUS s) for female stress urinary incontinence through an updated systematic review and meta‐analysis of randomized controlled trials ( RCT s) comparing these two surgical methods. A literature review of all RCT s comparing SIMS s (Mini‐Arc, Contasure‐Needleless, Ophira, Tissue Fixation System and Ajust), except TVT ‐Secur, with SMUS s was performed. The Medline, Embase, Scopus, Web of Science and Cochrane Controlled Trial Register databases were reviewed. We retrieved 29 RCT s (including a total of 2 986 patients) that compared SIMS s, except TVT ‐Secur, with SMUS s. Meta‐analysis of long‐term results showed no significant difference in the patient‐reported cure rate (odds ratio [ OR ] 0.67, 95% confidence interval [ CI ] 0.44–1.60); however, we found that SMUS s had a significantly superior objective cure rate ( OR 0.68, 95% CI 0.47–0.99; P = 0.04). SIMS s were associated with a significantly shorter operation time, lower immediate postoperative pain based on a visual analogue scale score, lower intra‐operative blood loss, and lower postoperative voiding dysfunction. The meta‐analysis showed clear evidence of the superiority of SMUS s over SIMS s, except TVT ‐Secur, in terms of the objective cure rate, after long‐term follow‐up; however, SIMS s were superior with respect to immediate postoperative pain, intra‐operative blood loss, and postoperative voiding dysfunction.