title: Comparison between the retropubic and transobturator approaches in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications.
abstract: OBJECTIVE
  This study aimed to compare the effectiveness and complications between the retropubic and transobturator approaches for the treatment of female stress urinary incontinence (SUI) by conducting a systematic review.
  
  
  METHODS
  We selected all randomized controlled trials (RCTs) that compared retropubic and transobturator sling placements for treatment of SUI. We estimated pooled odds ratios and 95% confidence intervals for intraoperative and postoperative outcomes and complications.
  
  
  RESULTS
  Six hundred twelve studies that compared retropubic and transobturator approaches to midurethral sling placement were identified, of which 16 were included in our research. Our study was based on results from 2646 women. We performed a subgroup analysis to compare outcomes and complications between the two approaches. The evidence to support the superior approach that leads to better objective/subjective cure rate was insufficient. The transobturator approach was associated with lower risks of bladder perforation (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.09-0.32), retropubic/vaginal hematoma (OR 0.32, 95% CI 0.16-0.63), and long-term voiding dysfunction (OR 0.32, 95% CI 0.17-0.61). However, the risk of thigh/groin pain seemed higher in the transobturator group (OR 2.53, 95% CI 1.72-3.72). We found no statistically significant differences in the risks of other complications between the two approaches.
  
  
  CONCLUSIONS
  This meta-analysis shows analogical objective and subjective cure rates between the retropubic and transobturator approaches to midurethral sling placement. The transobturator approach was associated with lower risks of several complications. However, good-quality studies with long-term follow-ups are warranted for further research.
authors.affiliation: Department of Urology, Cangzhou People Hospital, Cangzhou, Hebei 061000, China.
authors.forename: Xincheng
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Urology, Cangzhou People Hospital, Cangzhou, Hebei 061000, China.
authors.forename: Qingsong
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Department of Urology, Cangzhou People Hospital, Cangzhou, Hebei 061000, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Sun
authors.affiliation: Department of Urology, Cangzhou People Hospital, Cangzhou, Hebei 061000, China.
authors.forename: Qinglu
authors.initials: Q
authors.lastname: Shi
mesh_terms: D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D053825:Suburethral Slings / Q000009:adverse effects; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014621:Vagina / Q000601:surgery