Traditional suburethral sling operations for urinary incontinence in women

C A Bezerra, H Bruschini, D J Cody
Cochrane Database of Systematic Reviews 2005, (3): CD001754

BACKGROUND: Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence.

OBJECTIVES: To determine the effects of traditional suburethral slings on stress incontinence alone or stress with other types of urinary (mixed) incontinence in comparison with other management options.

SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 22 December 2004), The UK National Research Register (Issue 1, 2001) and the reference lists of relevant articles. We hand searched the proceedings of the Brazilian Congress of Urology from 1991 to 2003, inclusive.

SELECTION CRITERIA: Randomised or quasi-randomised trials that included traditional suburethral slings for the treatment of stress or mixed urinary incontinence.

DATA COLLECTION AND ANALYSIS: All three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data.

MAIN RESULTS: Thirteen trials were identified including 760 women of whom 627 were treated with suburethral slings. Five compared suburethral slings with open abdominal retropubic colposuspension (Burch/Marshall-Marchetti-Krantz) and one compared suburethral slings with needle suspension (Stamey). In six trials, different types of suburethral sling were compared with each other. Nine types of slings were included (Teflon, polytetrafluoroethylene, prolene used for transvaginal tape (TVT), porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia). There were no comparisons of suburethral sling with anterior repair, laparoscopic retropubic suspension, peri-urethral injections or artificial sphincters. One trial compared surgery (including slings) with anticholinergic medication.There were no statistically significant differences between traditional slings and other types of continence surgery, or between one type of traditional sling and another sling. Confidence intervals around the estimates were wide, reflecting the few data available, and so clinically important differences could not be ruled out.

AUTHORS' CONCLUSIONS: The data on sub urethral sling operations remain too few to address the effects of this type of surgical treatment. Few trials are reported by authors in a complete fashion and most information came from abstracts presented in annual meetings. The broader effects of suburethral slings could not be established since trials did not include appropriate outcome measures such as general health status, health economics, pad testing, third party analysis and time to return to normal activity level. Data obtained from thirteen trials did not provide reliable estimates because of their sizes, and heterogeneity of designs, populations studied, and types of comparisons made. Reliable evidence on which to judge whether or not suburethral slings are better or worse than other surgical or conservative management is currently not available.

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