Abstract
Purpose
We conducted this review to summarize the short-term and long-term efficacy of several midurethral sling procedures on quality of life (QoL) improvement based on incontinence-specific QoL measures in clinical trials among women with stress urinary incontinence (SUI).
Methods
We searched MEDLINE (January 1966 to March 2015), EMBASE (January 1988 to March 2015), and the Cochrane Incontinence Group Specialised Register (March 2015). Only randomized controlled trials (RCTs) were eligible in this analysis.
Results
We identified 13 different condition-specific instruments in the included 31 RCTs; the Urogenital Distress Inventory (UDI), the Incontinence Impact Questionnaire (IIQ), and Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire-12 (PISQ-12) were the most frequently used methods to measure QoL among women with SUI. We found that the improvement in sexual function (as assessed by PISQ-12) score was significantly higher in the single-incision slings group than in the TO-TVT group (WMD 1.06; 95 % CI 0.58–1.54); the post-operative pain visual analogue scale scores in the single-incision slings group was significantly lower than that in the TO-TVT group (WMD −1.59; 95 % CI −2.28 to −0.89). TO-TVT-treated patients had significantly greater reductions in total UDI scores (WMD 2.28; 95 % CI 1.77–2.80) and total IIQ scores (WMD 0.89; 95 % CI 0.26–1.52) than TVT-treated patients. The reduction in the total UDI score was significantly higher in the RP-TVT group than in the TO-TVT group (WMD −1.00; 95 % CI −1.65 to −0.35). Subgroup analysis of the total UDI score showed a significantly greater improvement in TO-TVT-treated patients than in TVT after long-term follow-up (>30 months), but no differences were detected after short-term follow-up (12–15 or 6 months).
Conclusions
Our meta-analysis indicated that consistent use of the UDI and IIQ with or without the PISQ-12 might promote options for comparisons between trials. Single-incision slings were associated with significantly higher improvement in sexual function and lower post-operative pain compared with standard midurethral slings, and the long-term efficacy of TO-TVT was superior to the TVT procedure in terms of reducing the distress caused by incontinence symptoms.
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References
Jokhio AH, Rizvi RM, Rizvi J, Macarthur C (2013) Urinary incontinence in women in rural Pakistan: prevalence, severity, associated factors and impact on life. BJOG Int J Obstet Gynaecol 120(2):180–186. doi:10.1111/1471-0528.12074
Kwon CS, Lee JH (2014) Prevalence, risk factors, quality of life, and health-care seeking behaviors of female urinary incontinence: results from the 4th Korean National Health and Nutrition Examination Survey VI (2007–2009). Int Neurourol J 18(1):31–36. doi:10.5213/inj.2014.18.1.31
Sangsawang B, Sangsawang N (2013) Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J 24(6):901–912. doi:10.1007/s00192-013-2061-7
Lose G, Fantl JA, Victor A et al (1998) Outcome measures for research in adult women with symptoms of lower urinary tract dysfunction. Neurourol Urodyn 17(3):255–262
JPT H, S G. Cochrane Handbook for Systematic Reviews of Interventions. Chichester, UK: Wiley and Sons. 2008
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. doi:10.1136/bmj.327.7414.557
Greenland S (1987) Quantitative methods in the review of epidemiologic literature. Epidemiol Rev 9:1–30
Tommaselli GA, D’Afiero A, Di Carlo C, Formisano C, Fabozzi A, Nappi C (2015) Tension-free vaginal tape-obturator and tension-free vaginal tape-Secur for the treatment of stress urinary incontinence: a 5-year follow-up randomized study. Eur J Obstet Gynecol Reprod Biol 185:151–155. doi:10.1016/j.ejogrb.2014.12.012
Schweitzer KJ, Milani AL, van Eijndhoven HW et al (2015) Postoperative pain after adjustable single-incision or transobturator sling for incontinence: a randomized controlled trial. Obstet Gynecol 125(1):27–34. doi:10.1097/AOG.0000000000000604
Tang X, Zhu L, Liang S, Lang J (2014) Outcome and sexual function after transobturator tape procedure versus tension-free vaginal tape SECUR: a randomized controlled trial. Menopause 21(6):641–645. doi:10.1097/gme.0000000000000119
Schellart RP, Oude Rengerink K, Van der Aa F et al (2014) A randomized comparison of a single-incision midurethral sling and a transobturator midurethral sling in women with stress urinary incontinence: results of 12-mo follow-up. Eur Urol 66(6):1179–1185. doi:10.1016/j.eururo.2014.07.027
Maslow K, Gupta C, Klippenstein P, Girouard L (2014) Randomized clinical trial comparing TVT Secur system and trans vaginal obturator tape for the surgical management of stress urinary incontinence. Int Urogynecol J 25(7):909–914. doi:10.1007/s00192-013-2312-7
Laurikainen E, Valpas A, Aukee P et al (2014) Five-year results of a randomized trial comparing retropubic and transobturator midurethral slings for stress incontinence. Eur Urol 65(6):1109–1114. doi:10.1016/j.eururo.2014.01.031
Djehdian LM, Araujo MP, Takano CC et al (2014) Transobturator sling compared with single-incision mini-sling for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol 123(3):553–561. doi:10.1097/aog.0000000000000148
Aigmuller T, Tammaa A, Tamussino K et al (2014) Retropubic vs. transobturator tension-free vaginal tape for female stress urinary incontinence: 3-month results of a randomized controlled trial. Int Urogynecol J 25(8):1023–1030. doi:10.1007/s00192-014-2384-z
Abdel-Fattah M, Hopper LR, Mostafa A (2014) Evaluation of transobturator tension-free vaginal tapes in the surgical management of mixed urinary incontinence: 3-year outcomes of a randomized controlled trial. J Urol 191(1):114–119. doi:10.1016/j.juro.2013.07.035
Ugurlucan FG, Erkan HA, Onal M, Yalcin O (2013) Randomized trial of graft materials in transobturator tape operation: biological versus synthetic. Int Urogynecol J 24(8):1315–1323. doi:10.1007/s00192-012-2008-4
Tommaselli GA, D’Afiero A, Di Carlo C, Formisano C, Fabozzi A, Nappi C (2013) Efficacy of a modified technique for TVT-O positioning: a twelve-month, randomized, single-blind, multicenter, non-inferiority study. Eur J Obstet Gynecol Reprod Biol 167(2):225–229. doi:10.1016/j.ejogrb.2012.11.014
Mostafa A, Agur W, Abdel-All M et al (2013) Multicenter prospective randomized study of single-incision mini-sling vs tension-free vaginal tape-obturator in management of female stress urinary incontinence: a minimum of 1-year follow-up. Urology 82(3):552–559. doi:10.1016/j.urology.2013.02.080
Schierlitz L, Dwyer PL, Rosamilia A et al (2012) Three-year follow-up of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol 119(2 Pt 1):321–327. doi:10.1097/AOG.0b013e31823dfc73
Scheiner DA, Betschart C, Wiederkehr S, Seifert B, Fink D, Perucchini D (2012) Twelve months effect on voiding function of retropubic compared with outside-in and inside-out transobturator midurethral slings. Int Urogynecol J 23(2):197–206. doi:10.1007/s00192-011-1543-8
Mostafa A, Agur W, Abdel-All M et al (2012) A multicentre prospective randomised study of single-incision mini-sling (Ajust(R)) versus tension-free vaginal tape-obturator (TVT-O) in the management of female stress urinary incontinence: pain profile and short-term outcomes. Eur J Obstet Gynecol Reprod Biol 165(1):115–121. doi:10.1016/j.ejogrb.2012.06.022
Schweitzer K, Cromheecke G, Milani A (2012) A randomized controlled trial comparing the TVT-O with the Ajust 1 as primary surgical treatment of female stress urinary incontinence. Int Urogynecol J 23(Suppl 2):1
Barber MD, Weidner AC, Sokol AI et al (2012) Single-incision mini-sling compared with tension-free vaginal tape for the treatment of stress urinary incontinence: a randomized controlled trial. Obstet Gynecol 119(2 Pt 1):328–337. doi:10.1097/AOG.0b013e318242a849
Ballester M, Bui C, Frobert JL et al (2012) Four-year functional results of the suburethral sling procedure for stress urinary incontinence: a French prospective randomized multicentre study comparing the retropubic and transobturator routes. World J Urol 30(1):117–122. doi:10.1007/s00345-011-0668-1
Abdel-Fattah M, Mostafa A, Familusi A, Ramsay I, N’Dow J (2012) Prospective randomised controlled trial of transobturator tapes in management of urodynamic stress incontinence in women: 3-year outcomes from the evaluation of transobturator tapes study. Eur Urol 62(5):843–851. doi:10.1016/j.eururo.2012.04.021
Zhang Y, Jiang M, Tong XW, Fan BZ, Li HF, Chen XL (2011) The comparison of an inexpensive-modified transobturator vaginal tape versus TVT-O procedure for the surgical treatment of female stress urinary incontinence. Taiwan J Obstet Gynecol 50(3):318–321. doi:10.1016/j.tjog.2011.01.033
Wang F, Song Y, Huang H (2010) Prospective randomized trial of TVT and TOT as primary treatment for female stress urinary incontinence with or without pelvic organ prolapse in Southeast China. Arch Gynecol Obstet. doi:10.1007/s00404-009-1098-9
Paparella R, Marturano M, Pelino L et al (2010) Prospective randomized trial comparing synthetic vs biological out-in transobturator tape: a mean 3-year follow-up study. Int Urogynecol J 21(11):1327–1336. doi:10.1007/s00192-010-1197-y
Palva K, Rinne K, Aukee P et al (2010) A randomized trial comparing tension-free vaginal tape with tension-free vaginal tape-obturator: 36-month results. Int Urogynecol J 21(9):1049–1055. doi:10.1007/s00192-010-1160-y
Kim JJ, Lee YS, Lee KS (2010) Randomized comparative study of the U- and H-type approaches of the TVT-secur procedure for the treatment of female stress urinary incontinence: one-year follow-up. Korean J Urol 51(4):250–256. doi:10.4111/kju.2010.51.4.250
Ross S, Robert M, Swaby C et al (2009) Transobturator tape compared with tension-free vaginal tape for stress incontinence: a randomized controlled trial. Obstet Gynecol 114(6):1287–1294. doi:10.1097/AOG.0b013e3181c2a151
Wang WY, Zhu L, Lang JH, Sun ZJ, Hai N (2008) Clinical study on tension-free vaginal tape and tension-free vaginal tape obturator for surgical treatment of severe stress urinary incontinence. Zhonghua fu chan ke za zhi. 43(3):180–184
Schierlitz L, Dwyer PL, Rosamilia A et al (2008) Effectiveness of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency: a randomized controlled trial. Obstet Gynecol 112(6):1253–1261. doi:10.1097/AOG.0b013e31818db391
Porena M, Costantini E, Frea B et al (2007) Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence: results of a multicentre randomised trial. Eur Urol 52(5):1481–1490. doi:10.1016/j.eururo.2007.04.059
Meschia M, Bertozzi R, Pifarotti P et al (2007) Peri-operative morbidity and early results of a randomised trial comparing TVT and TVT-O. Int Urogynecol J Pelvic Floor Dysfunct 18(11):1257–1261. doi:10.1007/s00192-007-0334-8
David-Montefiore E, Frobert JL, Grisard-Anaf M et al (2006) Peri-operative complications and pain after the suburethral sling procedure for urinary stress incontinence: a French prospective randomised multicentre study comparing the retropubic and transobturator routes. Eur Urol 49(1):133–138. doi:10.1016/j.eururo.2005.09.019
de Tayrac R, Deffieux X, Droupy S, Chauveaud-Lambling A, Calvanese-Benamour L, Fernandez H (2004) A prospective randomized trial comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of stress urinary incontinence. Am J Obstet Gynecol 190(3):602–608. doi:10.1016/j.ajog.2003.09.070
Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res 3(5):291–306
Ross S, Soroka D, Karahalios A, Glazener CM, Hay-Smith EJ, Drutz HP (2006) Incontinence-specific quality of life measures used in trials of treatments for female urinary incontinence: a systematic review. Int Urogynecol J Pelvic Floor Dysfunct 17(3):272–285. doi:10.1007/s00192-005-1357-7
Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C (2003) A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 14(3):164–168; discussion 8. doi:10.1007/s00192-003-1063-2
Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl JA (1995) Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn 14(2):131–139
Patrick DL, Martin ML, Bushnell DM, Yalcin I, Wagner TH, Buesching DP (1999) Quality of life of women with urinary incontinence: further development of the incontinence quality of life instrument (I-QOL). Urology 53(1):71–76
Bushnell DM, Martin ML, Summers KH, Svihra J, Lionis C, Patrick DL (2005) Quality of life of women with urinary incontinence: cross-cultural performance of 15 language versions of the I-QOL. Qual Life Res 14(8):1901–1913. doi:10.1007/s11136-005-5266-5
Bjelic-Radisic V, Dorfer M, Tamussino K et al (2007) The Incontinence Outcome Questionnaire: an instrument for assessing patient-reported outcomes after surgery for stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 18(10):1139–1149. doi:10.1007/s00192-007-0302-3
Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P (2004) ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn 23(4):322–330. doi:10.1002/nau.20041
Mostafa A, Lim CP, Hopper L, Madhuvrata P, Abdel-Fattah M (2014) Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and meta-analysis of effectiveness and complications. Eur Urol 65(2):402–427. doi:10.1016/j.eururo.2013.08.032
Nambiar A, Cody JD, Jeffery ST (2014) Single-incision sling operations for urinary incontinence in women. Cochrane Database Syst Rev 6:CD008709. doi:10.1002/14651858.CD008709.pub2
Nilsson CG, Palva K, Rezapour M, Falconer C (2008) Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 19(8):1043–1047. doi:10.1007/s00192-008-0666-z
Latthe PM, Foon R, Toozs-Hobson P (2007) Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG Int J Obstet Gynaecol 114(5):522–531. doi:10.1111/j.1471-0528.2007.01268.x
Acknowledgments
The authors would like to thank all authors of the included studies and all of the anonymous peer reviewers.
Conflict of interest
The authors declare that they have no possible conflicts of interest in the manuscript, including financial, consultant, institutional, and other relationships that might lead to bias or a conflict of interest.
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Fan, Y., Huang, Z. & Yu, D. Incontinence-specific quality of life measures used in trials of sling procedures for female stress urinary incontinence: a meta-analysis. Int Urol Nephrol 47, 1277–1295 (2015). https://doi.org/10.1007/s11255-015-1020-2
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DOI: https://doi.org/10.1007/s11255-015-1020-2