Laparoscopic versus open colposuspension for urodynamic stress incontinence.
OBJECTIVE
Laparoscopic colposuspension aims to alleviate urodynamic stress incontinence whilst minimizing operative morbidity and mortality.The present study compared laparoscopic to open surgery with regards to short-term outcomes.


METHODS
Meta-analysis of comparative studies published between 1995 and 2006 of laparoscopic versus open colposuspension was performed. End points evaluated were operative outcomes and subjective/objective cure. A random-effect model was used and sensitivity analysis performed to account for bias in patient selection.


RESULTS
Sixteen studies matched the selection criteria, reporting on 1,807 patients, of whom 861 (47.6%) underwent laparoscopic and 946 (52.4%) underwent open colposuspension length of hospital stay (WMD = -1.52 days, CI = -2.08, -0.96 days) and return to normal life (WMD = -1.51 weeks, CI = -3.02, 0.01 weeks) were significantly reduced following laparoscopic surgery. These findings remained consistent on sensitivity analysis. Bladder injuries occurred more often in the laparoscopic group (OR = 2.23, CI = 1.11, 4.50), but only with marginal statistical significance. Comparable bladder injury rates were found when studies were matched for quality, year, and randomized trials. Cure rates were similar between the two procedures at 2 years follow-up.


CONCLUSIONS
Laparoscopic colposuspension results in a significant reduction in hospital stay and earlier return to work, with a possible increased risk of bladder injury. When performed by appropriately experienced surgeons it may be a safe option with advantages for the patient, but further randomized controlled trials should be undertaken to evaluate continence in the longer term at 5 years.
Tan
Emile
E
Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College, London, United Kingdom.
Tekkis
Paris P
PP
Cornish
Julie
J
Teoh
Tiong G
TG
Darzi
Ara W
AW
Khullar
Vik
V
D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures