Sling surgery for stress urinary incontinence in women

A systematic review and metaanalysis

Megan O. Schimpf, David D. Rahn, Thomas L. Wheeler, Minita Patel, Amanda B. White, Francisco J. Orejuela, Sherif A. El-Nashar, Rebecca U. Margulies, Jonathan L. Gleason, Sarit O. Aschkenazi, Mamta M. Mamik, Renée M. Ward, Ethan M. Balk, Vivian W. Sung

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume211
Issue number1
DOIs
StatePublished - 2014

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Stress Urinary Incontinence
Suburethral Slings
Odds Ratio
Confidence Intervals
Randomized Controlled Trials
Overactive Urinary Bladder
Reoperation
Decision Making
Language
Guidelines

Keywords

  • Burch urethropexy
  • midurethral sling
  • pubovaginal sling
  • single-incision sling
  • stress urinary incontinence

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Sling surgery for stress urinary incontinence in women : A systematic review and metaanalysis. / Schimpf, Megan O.; Rahn, David D.; Wheeler, Thomas L.; Patel, Minita; White, Amanda B.; Orejuela, Francisco J.; El-Nashar, Sherif A.; Margulies, Rebecca U.; Gleason, Jonathan L.; Aschkenazi, Sarit O.; Mamik, Mamta M.; Ward, Renée M.; Balk, Ethan M.; Sung, Vivian W.

In: American Journal of Obstetrics and Gynecology, Vol. 211, No. 1, 2014.

Research output: Contribution to journalArticle

Schimpf, MO, Rahn, DD, Wheeler, TL, Patel, M, White, AB, Orejuela, FJ, El-Nashar, SA, Margulies, RU, Gleason, JL, Aschkenazi, SO, Mamik, MM, Ward, RM, Balk, EM & Sung, VW 2014, 'Sling surgery for stress urinary incontinence in women: A systematic review and metaanalysis', American Journal of Obstetrics and Gynecology, vol. 211, no. 1. https://doi.org/10.1016/j.ajog.2014.01.030
Schimpf, Megan O. ; Rahn, David D. ; Wheeler, Thomas L. ; Patel, Minita ; White, Amanda B. ; Orejuela, Francisco J. ; El-Nashar, Sherif A. ; Margulies, Rebecca U. ; Gleason, Jonathan L. ; Aschkenazi, Sarit O. ; Mamik, Mamta M. ; Ward, Renée M. ; Balk, Ethan M. ; Sung, Vivian W. / Sling surgery for stress urinary incontinence in women : A systematic review and metaanalysis. In: American Journal of Obstetrics and Gynecology. 2014 ; Vol. 211, No. 1.
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abstract = "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.",
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T1 - Sling surgery for stress urinary incontinence in women

T2 - A systematic review and metaanalysis

AU - Schimpf, Megan O.

AU - Rahn, David D.

AU - Wheeler, Thomas L.

AU - Patel, Minita

AU - White, Amanda B.

AU - Orejuela, Francisco J.

AU - El-Nashar, Sherif A.

AU - Margulies, Rebecca U.

AU - Gleason, Jonathan L.

AU - Aschkenazi, Sarit O.

AU - Mamik, Mamta M.

AU - Ward, Renée M.

AU - Balk, Ethan M.

AU - Sung, Vivian W.

PY - 2014

Y1 - 2014

N2 - 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.

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.

KW - Burch urethropexy

KW - midurethral sling

KW - pubovaginal sling

KW - single-incision sling

KW - stress urinary incontinence

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