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Effectiveness of midurethral slings in recurrent stress urinary incontinence: a systematic review and meta-analysis

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Abstract

Introduction and hypothesis

Midurethral slings (MUS) are the gold standard primary procedure for the surgical treatment of stress urinary incontinence (SUI). There is no robust evidence on the success with MUS in the treatment of recurrent SUI. Our objective was to evaluate the effectiveness and complications of MUS in women with recurrent SUI by systematic review and meta-analysis of the literature.

Methods

A systematic literature search was carried out (up to August 2011) using relevant search terms in MEDLINE, EMBASE, CENTRAL and Google Scholar. Relevant randomised controlled trials (RCT) and prospective studies were selected and then analysed by two independent reviewers. Meta-analysis of cure stated in prospective cohort studies was performed with a random effects model using Stata 8.

Results

There was 1 randomised trial and 11 good quality prospective studies included in this systematic review. The overall subjective cure rate per meta-analysis of prospective cohort studies following MUS for recurrent SUI after any previous surgery was found to be 78.5 % [95 % confidence interval (CI) 69–88] at the follow-up of 29.72 ± 29.49 months. The subjective cure rate following MUS after previous failed MUS was 73.3 % (95 % CI 55–97) at the follow-up of 15.7 ± 7.7 months.

Conclusions

The studies report good cure rates of SUI after MUS surgery following previous incontinence surgery (62–100 %). There seems to be a lower cure rate with transobturator compared to the retropubic tape for recurrent SUI after previous surgery.

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Abbreviations

MUS:

Midurethral sling

SUI:

Stress urinary incontinence

TVT:

Tension-free vaginal tape

TOT:

Transobturator tape

KHQ:

King’s Health Questionnaire

PISQ-12:

Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire

PGI-I:

Patient Global Impression of Improvement

ICIQ-SF:

International Consultation on Incontinence Questionnaire-Short Form

ISI:

Incontinence Severity Index

MMK:

Marshall-Marchetti-Krantz procedure

DIS:

Detrusor instability score

VAS:

Visual analogue scale

UDI:

Urogenital Distress Inventory

IIQ:

Incontinence Impact Questionnaire

UISS:

Urinary Incontinence Severity Score

VLPP:

Valsalva leak point pressure

MUCP:

Mean urethral closure pressure

ICIQ:

International Consultation on Incontinence Questionnaire

PVR:

Post-void residual

ISD:

Intrinsic sphincter deficiency

UDS:

Urodynamics

UPP:

Urethral pressure profilometry

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Acknowledgments

Dr. Ioannis Gallos for his help with Stata analysis.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Obstetrics & Gynaecology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK

    Ashish Pradhan

  2. Department of Obstetrics & Gynaecology, Manor Hospital, Walsall, WS2 9PS, UK

    Preeti Jain

  3. Birmingham Women’s NHS Foundation Trust, Metchley Park Road, Edgbaston, Birmingham, UK

    Pallavi M. Latthe

Authors
  1. Ashish Pradhan
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  2. Preeti Jain
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  3. Pallavi M. Latthe
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Correspondence to Ashish Pradhan.

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Pradhan, A., Jain, P. & Latthe, P.M. Effectiveness of midurethral slings in recurrent stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 23, 831–841 (2012). https://doi.org/10.1007/s00192-012-1803-2

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  • DOI: https://doi.org/10.1007/s00192-012-1803-2

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