BERKELEY, CA (UroToday.com) - The Society of Gynecologic Surgeons Systematic Review Group, composed of practicing urogynecologists and pelvic surgeons, chooses topics of interest to its members to review and then provides practice guidelines when supported by the evidence. We chose stress urinary incontinence (SUI) surgery because of the range of surgical options available today as well as the breadth of literature to review. We found high-quality studies that permitted us to perform meta-analyses as well as to write practice guidelines, which were vetted through the SGS Executive Committee and membership before being published as part of the manuscript.
The largest number of studies investigated the comparison of retropubic vs. transobturator midurethral slings, and overall there was no significant difference between these slings for cure rates, although there were differences by adverse events that may direct counseling and procedure choice. Questions still outstanding in the literature involve subpopulations of women seeking cure of SUI, notably including women with poor sphincter function and/or prior surgical failure. These conditions were often not separately investigated in the studies we reviewed, or were poorly defined. As they are of high interest to providers and patients, they merit future individual study.
Our review and meta-analyses concluded that the newer minislings have poor cure rates compared to traditional full-length midurethral slings. However, most of these studies used a minisling that has since been removed from the market, and these results, therefore, cannot be generalized to the currently available products. Certainly these currently available products should be studied to determine the best option for patients, considering this difference in cure rates.
As with many surgical decisions, there are multiple factors that contribute to the ‘right’ choice. Each surgeon should examine their own personal results in certain patient populations, as these may differ from surgeons who perform studies and the women included in those studies. Patients often have individual goals and concerns, and those require careful counseling to ascertain and then to direct surgical choice. The trade-off between benefits and risks is differently perceived by patients, and counseling should address those factors. Our paper includes extensive information about cure rates, quality-of-life outcomes where available, and adverse events to help guide those discussions.
Megan Schimpf, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Associate Professor, Obstetrics and Gynecology
Female Pelvic Medicine and Reconstructive Surgery
Ambulatory Care Unit (ACU) Medical Director, Von Voigtlander Obstetrics and Gynecology Clinic
University of Michigan
Ann Arbor, MI USA