title: Surgical treatment of neurogenic stress urinary incontinence: A systematic review of quality assessment and surgical outcomes.
abstract: BACKGROUND
  There are many opinions but little firm knowledge about the optimal treatment of neurogenic stress urinary incontinence (NSUI).
  
  
  OBJECTIVE
  To scrutinize the quality and surgical outcomes of the available treatment modalities in the published literature.
  
  
  METHODS
  A systematic review of the published literature from Pub Med and Web of Science was undertaken for studies describing surgical treatment of NSUI between 1990 and 2013. A checklist of criteria of methodological and reporting quality of interventions in urological publications was applied to assess quality of the retrieved publications. Surgical outcomes of success, failure, and reoperation were calculated. Statistical analyses included one-way ANOVA and post-hoc tests to determine significant differences between groups.
  
  
  RESULTS
  Thirty studies were identified with Level 3 evidence. The quality of reporting was 43-81%, with significantly higher quality noted in studies published after 2002 (64% vs. 45%, P < 0.0001). None of the studies followed a randomized controlled trial (RCT) design. Three primary surgical procedures were used in 29 of 30 studies: artificial urinary sphincter (AUS), urethral slings, and urethral bulking agents. One study used a ProACT device. AUS was considered more successful than urethral bulking agents (77 ± 15% vs. 27 ± 20%, P = 0.002). Urethral bulking agents reported higher failures than urethral sling procedures (49 ± 16% vs. 21 ± 19%, P = 0.016) and AUS (21 ± 19% vs. 10 ± 11%, P < 0.002).
  
  
  CONCLUSIONS
  The quality of evidence obtained from non-RCTs is modest. Surgeries for NSUI have relatively high success rates but also high complication rates in this highly heterogeneous population. More studies using modern techniques are required to update our knowledge.
authors.affiliation: Department of Urology, Radboud University Medical Centre Nijmegen, The Netherlands.|Department of Urology, Sohag University Hospital, Sohag, Egypt.
authors.forename: Fawzy
authors.identifier: http://orcid.org/0000-0003-2894-3898
authors.initials: F
authors.lastname: Farag
authors.affiliation: Department of Urology, Radboud University Medical Centre Nijmegen, The Netherlands.
authors.forename: Martin
authors.initials: M
authors.lastname: Koens
authors.affiliation: Department of Urology, University of Tuebingen, Tuebingen, Germany.
authors.forename: Karl-Dietrich
authors.initials: KD
authors.lastname: Sievert
authors.affiliation: Department of Urology, UZ Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ridder
authors.affiliation: Department of Urology, Radboud University Medical Centre Nijmegen, The Netherlands.
authors.forename: Wout
authors.initials: W
authors.lastname: Feitz
authors.affiliation: Department of Urology, Radboud University Medical Centre Nijmegen, The Netherlands.
authors.forename: John
authors.initials: J
authors.lastname: Heesakkers
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D011785:Quality Assurance, Health Care; D012086:Reoperation; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
keywords: artificial; bulking agents; injection therapy; spinal cord injuries; spinal dysraphism; stress; suburethral slings; urinary incontinence; urinary sphincter