title: Surgical treatment of recurrent stress urinary incontinence in women: a systematic review and meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  Recurrent stress urinary incontinence (R-SUI) represents a management dilemma; however, only a limited number of randomised controlled trials (RCTs) have assessed the various surgical procedures used for its treatment.
  
  
  OBJECTIVE
  To assess the effectiveness and complications of various surgical procedures for the treatment of female R-SUI.
  
  
  METHODS
  A prospective peer-reviewed protocol was prepared a priori. A systematic literature review of all published RCTs comparing surgical procedures for treatment of R-SUI was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Data were analysed using RevMan 5.
  
  
  RESULTS
  We conducted a literature search from 1945 to February 2013. Data were available for a total of 350 women in 10 RCTs with a mean follow-up of 18.1 mo. Meta-analysis was possible for the comparison of retropubic tension-free vaginal tape (RP-TVT) versus transobturator tension-free vaginal tape (TO-TVT) in five RCTs (n = 135). There was no statistically significant difference between RP-TVT and TO-TVT in the patient-reported improvement (odds ratio [OR]: 0.84, 95% confidence interval [CI], 0.41-1.69) or objective cure/improvement (OR: 1.75; 95% CI, 0.86-3.54). One RCT showed a trend towards a higher rate of patient-reported and objective cure/improvement with the inside-out TO-TVT compared with the outside-in; however, it was not statistically significant (OR: 3.00; 95% CI, 0.85-10.57, and OR: 3.32; 95% CI, 0.96-11.41, respectively). There was no significant difference between Burch colposuspension and RP-TVT (one RCT) in patient-reported improvement (OR: 0.33; 95% CI, 0.01-8.57) or objective cure/improvement (OR: 0.52; 95% CI, 0.13-2.05).
  
  
  CONCLUSIONS
  This meta-analysis shows no evidence of a significant difference in patient-reported and objective cure/improvement rates between RP-TVT and TO-TVT in the surgical treatment of women with R-SUI. However, due to the relatively low number of patients, the analysis might be underpowered. This review highlights the poor level of evidence in this field and the need for well-designed clinical trials to address this important clinical dilemma.
authors.affiliation: NHS Ayrshire & Arran, NHS Research Scotland, Kilmarnock, UK. Wael.Agur@glasgow.ac.uk
authors.forename: Wael
authors.initials: W
authors.lastname: Agur
authors.forename: Mohamed
authors.initials: M
authors.lastname: Riad
authors.forename: Silvia
authors.initials: S
authors.lastname: Secco
authors.forename: Heather
authors.initials: H
authors.lastname: Litman
authors.forename: Priya
authors.initials: P
authors.lastname: Madhuvrata
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Fattah
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation
keywords: Colposuspension; Complications; Recurrent urinary incontinence; Suburethral slings; Tension-free vaginal tape; Transobturator tape; Urodynamic stress incontinence