To assess and compare the long-term efficacy and safety of single-incision mini-slings (SIMS) except tension-free vaginal tape (TVT)-Secur with standard midurethral slings (SMUS) for female stress urinary incontinence through an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing these 2 surgical methods.
A literature review of all RCTs comparing SIMS (Mini-Arc, Contasure-Needleless, Ophira, Tissue Fixation System, and Ajust) except TVT-Secur with SMUS was performed. The Medline, Embase, Scopus, Web of Science, and Cochrane Controlled Trial Register databases were reviewed.
We retrieved 29 RCTs (N=2986) comparing SIMS except TVT-Secur with SMUS. Meta-analysis of long-term results showed no significant difference in the patient-reported cure rate (odds ratio [OD], 0.67; 95% confidence interval [CI], 0.44-1.60); however, we found that SMUS had a significantly superior objective cure rate (OD, 0.68; 95% CI, 0.47-0.99; p=0.04). SIMS were associated with a significantly shorter operation time, lower immediate postoperative pain based on the visual analog scale score, lower intraoperative blood loss, and lower postoperative voiding dysfunction.
The meta-analysis showed clear evidence of the superiority of SMUS over SIMS except TVT-Secur, in terms of the objective cure rate, on long-term follow-up. However, SIMS are superior with respect to immediate postoperative pain, intraoperative blood loss, and postoperative voiding dysfunction. This article is protected by copyright. All rights reserved.
BJU international. 2018 Jun 21 [Epub ahead of print]
Aram Kim, Min Seo Kim, Young-Jin Park, Woo Suk Choi, Hyoung Keun Park, Sung Hyun Paick, Myung-Soo Choo, Hyeong Gon Kim
Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea., Korea University, College of Medicine, Seoul, Korea., Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.