Retropubic versus transobturator midurethral slings in patients at a high risk of recurrent stress incontinence: A systemic review and meta-analysis.

The efficacy and safety of retropubic (RP) and transobturator (TO) tension-free vaginal tape (TVT) midurethral slings (MUSs) for SUI patients with risk factors for recurrence remain controversial. We compare the techniques within selected groups (patients with obesity, intrinsic sphincter deficiency [ISD], pelvic organ prolapse [POP], and SUI recurrence after initial MUS).

We used the PRISMA statement to report the methods and results of the present review. Randomized controlled trials and observational studies were included. Objective cure rate, subjective cure rate, and complication rate were assessed using odds ratio (ORs) with 95% confidence intervals (CIs). The protocol for the present meta-analysis was registered in the PROSPERO database (No. CRD42018102233).

We retrieved 28 studies (n=2607) to compare the efficacy and safety of RP-TVT versus TO-TVT in selected groups (mean follow-up, 26.9 months). Meta-analysis of objective cure rate showed significant superiority of RP-TVT to TO-TVT in overall patients (OR, 3.37; 95% CI, 2.55-4.43; P<.00001; I2=37%) and in each subpopulation. RP-TVT was also significantly superior to TO-TVT in the subjective cure rate in overall patients (OR, 2.01; 95% CI, 1.45-2.80; P<.0001; I2=0%) and in those with ISD and SUI recurrence after MUS. There was no significant difference in overall complications between RP-TVT and TO-TVT (OR, 1.22; 95% CI, 0.89-1.66; P=.21, I2=0%).

The meta-analysis showed the superiority of RP-TVT to TO-TVT in objective and subjective cure rates in patients with obesity, ISD, POP, and SUI recurrence after MUS. RP-TVT also has a comparable morbidity to TO-TVT.

The Journal of urology. 2019 Mar 13 [Epub ahead of print]

Aram Kim, Min Seo Kim, Young-Jin Park, Woo Suk Choi, Hyoung Keun Park, Sung Hyun Paick, Hyeong Gon Kim

Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea., Korea University, College of Medicine , Seoul , Korea.