International Urogynecology Journal

, Volume 23, Issue 7, pp 831–841

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

Review Article

DOI: 10.1007/s00192-012-1803-2

Cite this article as:
Pradhan, A., Jain, P. & Latthe, P.M. Int Urogynecol J (2012) 23: 831. doi:10.1007/s00192-012-1803-2

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.

Keywords

Midurethral slings Stress urinary incontinence Tension-free tape Transobturator tape Recurrent urinary incontinence 

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

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Ashish Pradhan
    • 1
  • Preeti Jain
    • 2
  • Pallavi M. Latthe
    • 3
  1. 1.Department of Obstetrics & GynaecologyAddenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustCambridgeUK
  2. 2.Department of Obstetrics & GynaecologyManor HospitalWalsallUK
  3. 3.Birmingham Women’s NHS Foundation TrustEdgbaston, BirminghamUK

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