title: A meta-analysis of the performance of retropubic mid urethral slings versus transobturator mid urethral slings.
abstract: OBJECTIVE
  We evaluate the efficacy and complications after retropubic and transobturator mid urethral slings in the treatment of female stress urinary incontinence.
  
  
  METHODS
  A systematic literature review was performed using MEDLINE®, limited to randomized controlled trials with a minimum followup of 1 year and type 1 grafts. Statistical analyses were performed using StatsDirect Version 2.7.9 (StatsDirect Ltd, Altrincham, UK).
  
  
  RESULTS
  Retropubic mid urethral sling procedures showed statistically significant improvements in objective cure (OR 1.35, 95% CI 1.10-1.67, p=0.005) and subjective cure (OR 1.24, 95% CI 1.04-1.49, p=0.02). Bladder perforations (OR 5.72, CI 2.94-11.12, p <0.0001) and bleeding (OR 2.65, CI 1.54-4.59, p=0.0005) were significantly more common with retropubic mid urethral slings, whereas vaginal perforations (OR 0.29, CI 0.15-0.56, p=0.0002) and neurological symptoms (OR 0.35, CI 0.25-0.5, p <0.0001) were more common with transobturator mid urethral slings. Operative time was significantly longer for retropubic mid urethral slings than transobturator mid urethral slings (OR 1.38, p <0.0001). No significant differences were noted in mesh erosions and exposure, urinary retention, infection, lower urinary tract symptoms and length of hospital stay.
  
  
  CONCLUSIONS
  Retropubic mid urethral slings showed better objective and subjective cure rates than transobturator mid urethral slings. However, bladder perforation and bleeding were more common with retropubic mid urethral slings. Operative time was longer for retropubic mid urethral slings. Transobturator mid urethral slings were associated with more cases of neurological symptoms and vaginal perforation.
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York; Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Seklehner
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Laudano
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Donghua
authors.initials: D
authors.lastname: Xie
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York. Electronic address: ril9010@med.cornell.edu.
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
mesh_terms: D005260:Female; D006801:Humans; D011474:Prosthesis Design; D053825:Suburethral Slings / Q000009:adverse effects; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: meta-analysis; stress; suburethral slings; urinary incontinence