Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and meta-analysis of effectiveness and complications.
BACKGROUND
An updated systematic review and meta-analysis of randomised controlled trials (RCTs) comparing single-incision mini-slings (SIMS) versus standard midurethral slings (SMUS) in the surgical management of female stress urinary incontinence (SUI).


OBJECTIVE
To evaluate the clinical efficacy, safety, and cost effectiveness of SIMS compared with SMUS in the treatment of female SUI.


METHODS
A literature search was performed for all RCTs and quasi-RCTs comparing SIMS with either transobturator tension-free vaginal tape (TO-TVT) or retropubic tension-free vaginal tape (RP-TVT). The literature search had no language restrictions and was last updated on May 2, 2013. The primary outcomes were patient-reported and objective cure rates at 12 to 36 mo follow-up. Secondary outcomes included operative data; peri- and postoperative complications, and repeat continence surgery. Data were analysed using RevMan software. Meta-analyses of TVT-Secur versus SMUS are presented separately as the former was recently withdrawn from clinical practice.


RESULTS
A total of 26 RCTs (n=3308 women) were included. After excluding RCTs evaluating TVT-Secur, there was no evidence of significant differences between SIMS and SMUS in patient-reported cure rates (risk ratio [RR]: 0.94; 95% confidence interval [CI], 0.88-1.00) and objective cure rates (RR: 0.98; 95% CI, 0.94-1.01) at a mean follow-up of 18.6 mo. These results pertained on comparing SIMS versus TO-TVT and RP-TVT separately. SIMS had significantly lower postoperative pain scores (weighted means difference [WMD]: -2.94; 95% CI, -4.16 to -1.73) and earlier return to normal activities and to work (WMD: -5.08; 95% CI, -9.59 to -0.56 and WMD: -7.20; 95% CI, -12.43 to -1.98, respectively). SIMS had a nonsignificant trend towards higher rates of repeat continence surgery (RR: 2.00; 95% CI, 0.93-4.31).


CONCLUSIONS
This meta-analysis shows that, excluding TVT-Secur, there was no evidence of significant differences in patient-reported and objective cure between currently used SIMS and SMUS at midterm follow-up while associated with more favourable recovery time. Results should be interpreted with caution due to the heterogeneity of the trials included.
University of Aberdeen, Aberdeen, UK.
Alyaa
A
Mostafa
Aberdeen Royal Infirmary, Aberdeen, UK.
Chou Phay
CP
Lim
University of Aberdeen, Aberdeen, UK.
Laura
L
Hopper
Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.
Priya
P
Madhuvrata
University of Aberdeen, Aberdeen, UK. Electronic address: m.abdelfattah@abdn.ac.uk.
Mohamed
M
Abdel-Fattah
D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D053825:Suburethral Slings; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000503:physiopathology / Q000601:surgery*; D001743:Urinary Bladder / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*
Midurethral sling; Mini-slings; Single-incision tapes; Stress urinary incontinence; Tension-free vaginal tape; Urinary incontinence