title: Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: a meta-analysis of effectiveness and complications.
abstract: BACKGROUND
  Single-incision mini-slings (SIMS) have been introduced for the treatment of female stress urinary incontinence (SUI); however, concerns have been raised regarding their efficacy. No systematic reviews or meta-analyses have previously assessed these relatively new procedures.
  
  
  OBJECTIVE
  To assess the current evidence of effectiveness and safety of SIMS compared with standard midurethral slings (SMUS) (retropubic and transobturator tension-free vaginal tapes) in the management of female SUI.
  
  
  METHODS
  We conducted a literature search from 1996 to January 2011. Meta-analysis of all randomised controlled trials (RCTs) comparing SIMS versus SMUS was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were analysed using Rev-Man 5. Primary outcomes were patient-reported and objective cure rates. Secondary outcomes included perioperative complications, quality of life (QoL) changes, and costs to health services.
  
  
  RESULTS
  A total of 758 women in nine RCTs with a mean follow-up of 9.5 mo were included. The mean age (52.3 vs 52.1 yr), body mass index (27.4 vs 27.7), and parity (2.4 and 2.4) were comparable for both groups. SIMS were associated with significantly lower patient-reported and objective cure rates at 6-12 mo compared with SMUS (risk ratio [RR]: 0.83; 95% confidence interval [CI], 0.70-0.99, and RR: 0.85; 95% CI, 0.74-0.97, respectively). SIMS were associated with significantly shorter operative time (weighed mean difference [WMD]: 8.67 min; 95% CI, 17.32 to -0.02), lower day 1 pain scores (WMD: 1.74; 95% CI, -2.58 to -0.09), and less postoperative groin pain (RR: 0.18; 95% CI, 0.04-0.72). Repeat continence surgery (RR: 6.72; 95% CI, 2.39-18.89) and de novo urgency incontinence (RR: 2.08; 95% CI, 1.01-4.28) were significantly higher in the SIMS group. There was no significant difference in the QoL scores between the groups (WMD: 33.46; 95% CI, -20.62 to 87.55). No studies compared cost to health services.
  
  
  CONCLUSIONS
  SIMS are associated with inferior patient-reported and objective cure rates on the short-term follow-up, as well as higher reoperation rates for SUI when compared with SMUS.
authors.affiliation: Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. m.abdelfattah@abdn.ac.uk
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Fattah
authors.forename: John A
authors.initials: JA
authors.lastname: Ford
authors.forename: Chou Phay
authors.initials: CP
authors.lastname: Lim
authors.forename: Priya
authors.initials: P
authors.lastname: Madhuvrata
mesh_terms: D016009:Chi-Square Distribution; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010149:Postoperative Pain / Q000209:etiology; D011474:Prosthesis Design; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D053825:Suburethral Slings; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000503:physiopathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*