Midurethral sling position and surgical outcome: A meta-analysis

There is still ongoing debate as to whether the outcome of the sling is determined by the position of the midurethral sling. In order to evaluate the potential impact of sling position on the outcomes of retropubic and transobturator sling procedures for stress urinary incontinence, it is necessary to conduct further investigations. We conducted a comprehensive search across various electronic databases such as PubMed, EMBASE, MEDLINE. Relevant data were extracted, organized in a table format, and analyzed using RevMan software for further analysis. This review comprised a total of 9 studies. The findings indicate that patients with TVT tape placement in the midurethra exhibited a slightly higher cure rate compared to those with proximal placement. Conversely, tape placement in the midurethra was associated with a significantly higher cure rate compared to distal placement [RR = 0.84, 95% CI (0.74-0.95), P < .05]. In the case of transobturator slings, tape positioning beneath the midurethra or distal urethra yielded better outcomes compared to placement near the bladder neck [RR = 0.74, 95% CI (0.57-0.94), P = .02; RR = 0.61, 95% CI (0.39-0.96), P = .03]. Based on 2D and 3D ultrasound imaging, differences in TVT placement appear to have minimal impact on the cure rate. However, the highest rate of failure after transobturator sling surgery is closely linked to the positioning.

Single Incision Mini-Sling Versus Mid-Urethral Sling (Transobturator/Retropubic) in Females With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis

Stress urine incontinence (SUI) is most common in middle-aged women and the second most common in those over 75. SUI causes significant discomfort and suffering for patients and has a considerable financial impact on the healthcare system. Conservative approaches are recommended as the first step in treatment. However, surgery is often necessary to improve a patient's quality of life due to the high failure rate of conservative treatments. A thorough literature review of studies published before March 2023 was conducted on the safety and effectiveness of single-incision mini slings (SIMS) and standard mid-urethral slings (MUS). PubMed, Embase, Cochrane Library, and Elsevier's ScienceDirect were used to retrieve the studies. Two reviewers independently searched and evaluated the data based on inclusion and exclusion criteria. Review Manager 5.4 software was used for meta-analysis. Included were seventeen studies involving 3,503 female SUI patients without intrinsic sphincter deficiency (ISD) or mixed urinary incontinence. According to the results of our meta-analysis, the clinical efficacy of SIMS is comparable to that of MUS in terms of objective cure rate (RR: 0.99; 95% CI: 0.95 to 1.03, p: 0.66, I2: 29%). In contrast, it increases the post-procedure International Consultation on Incontinence Questionnaire (ICIQ) score (WMD: 0.08; 95% CI: -0.08 to 0.08). CI: -0.02 to 0.18, p: 0.11, I2: 55%) and improves the PGI-I score to a greater extent (RR: 1.04; 95% CI: 0.96 to 1.08, p: 0.36, I2: 76%). In contrast, there is no difference between the two groups regarding patient satisfaction (RR: 0.96; 95% CI: 0.92 to 1.01, p: 0.16, I2: 0%) and Sandvik score reduction (RR: 0.98; 95% CI: 0.94 to 1.02, p: 0.35, I2: 0%). In conclusion, single-incision mid-urethral slings (SIMS) are as effective as mid-urethral slings (MUS) for treating pure stress urinary incontinence (SUI) without intrinsic sphincter deficiency (ISD), with a shorter operation time. However, the SIMS procedure has a higher incidence of dyspareunia. At the same time, bladder perforation, mesh-related complications, pelvic/groin pain, urinary tract infection (UTI), worsening urgency, dysuria, and pain score are less likely to occur with SIMS. Only the decrease in pelvic/groin pain was statistically significant.