title: Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness.
abstract: OBJECTIVE
  To evaluate the efficacy of tension-free vaginal tape (TVT) compared with other surgical treatments for stress urinary incontinence (SUI) and with other tension-free midurethral slings.
  
  
  METHODS
  A systematic review of the literature was performed in January 2007 using MEDLINE, Embase, and Web of Science. The searches used both "MeSH" and "free text" protocols. Meta-analysis was conducted using the Review Manager software 4.2 (Cochrane Collaboration).
  
  
  RESULTS
  Our search identified 37 randomized controlled trials. According to the Jadad score, the quality of the evaluated studies was limited in most papers. TVT outperformed Burch colposuspension in terms of postoperative continence rates (odds ratio [OR] from 0.38 to 0.59, according to the different end points), whereas success rates were similar after TVT and pubovaginal slings. Comparing TVT to the other retropubic tension-free midurethral vaginal slings, TVT was more efficacious than both intravaginal slingplasty (IVS; OR = 0.47; p = 0.007) and suprapubic arc (SPARC; OR from 0.53 to 0.56 according to the different evaluated end points). Indeed, the available data suggest similar efficacy for retropubic and trans-obturator tapes both in terms of subjective (OR = 0.98; p = 0.92) and objective (OR = 0.81; p = 0.34) cure rates.
  
  
  CONCLUSIONS
  Our meta-analysis showed that TVT outperformed Burch colposuspension; efficacies of TVT and pubovaginal sling were similar. TVT was more efficacious than IVS and SPARC, whereas retropubic and trans-obturator tapes showed overlapping cure rates. The poor quality of most of the studies, both in terms of methodologic and clinical parameters, limits the strengths of the recommendations derived by the meta-analysis.
authors.affiliation: Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Rafael
authors.initials: R
authors.lastname: Boscolo-Berto
authors.forename: Silvia
authors.initials: S
authors.lastname: Secco
authors.forename: Stefano
authors.initials: S
authors.lastname: Cavalleri
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
mesh_terms: D005260:Female; D006801:Humans; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation*; D016032:Randomized Controlled Trials as Topic; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*