Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine , Seoul , Korea.
College of Medicine, Korea University , Seoul , Korea.
J Urol. 2019 Jul;202(1):132-142. doi: 10.1097/JU.0000000000000222. Epub 2019 Jun 7.
The efficacy and safety of retropubic and transobturator tension-free vaginal tape mid urethral slings remain controversial in patients with stress urinary incontinence and risk factors for recurrence. We compared the techniques after initial mid urethral sling insertion in select groups, including patients with obesity, intrinsic sphincter deficiency, pelvic organ prolapse and recurrent stress urinary incontinence.
We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement to report the methods and results of the current review. Randomized controlled trials and observational studies were included. We assessed the objective and subjective cure rates, and the complication rate using the OR with the 95% CI. The protocol of the current meta-analysis was registered on PROSPERO (No. CRD42018102233).
We retrieved 28 studies in a total of 2,607 patients to compare the efficacy and safety of retropubic vs transobturator tension-free vaginal tape in select groups (mean followup 26.9 months). Meta-analysis of the objective cure rate showed the significant superiority of retropubic compared to transobturator tension-free vaginal tape in patients overall (OR 3.37, 95% CI 2.55-4.43, p <0.00001, I = 37%) and in each subpopulation. The subjective cure rate of retropubic tension-free vaginal tape was also significantly superior to that of transobturator tension-free vaginal tape in in patients overall (OR 2.01, 95% CI 1.45-2.80, p <0.0001, I = 0%) and in those with intrinsic sphincter deficiency and recurrent stress urinary incontinence after mid urethral sling insertion. There was no significant difference in overall complications between retropubic and transobturator tension-free vaginal tape (OR 1.22, 95% CI 0.89-1.66, p = 0.21, I = 0%).
The meta-analysis showed the superiority of retropubic tension-free vaginal tape over transobturator tension-free vaginal tape in terms of the objective and subjective cure rates in patients with obesity, intrinsic sphincter deficiency, pelvic organ prolapse and recurrent stress urinary incontinence after mid urethral sling insertion. Retropubic tension-free vaginal tape also has morbidity comparable to that of transobturator tension-free vaginal tape.
经阴道耻骨后和经闭孔无张力阴道吊带术治疗压力性尿失禁的疗效和安全性在伴有复发风险的压力性尿失禁和存在复发因素的患者中仍存在争议。我们比较了在选择的患者群体中初次行尿道中段吊带术时这两种技术的效果，包括肥胖、固有括约肌缺陷、盆腔器官脱垂和复发性压力性尿失禁患者。
我们使用 PRISMA（系统评价和荟萃分析的首选报告项目）声明报告了当前综述的方法和结果。纳入了随机对照试验和观察性研究。我们使用 OR 和 95%CI 评估了客观治愈率和主观治愈率以及并发症发生率。当前荟萃分析的方案已在 PROSPERO（编号 CRD42018102233）上注册。
我们共检索到 28 项研究，共纳入 2607 例患者，以比较耻骨后与经闭孔无张力阴道吊带在选择的患者群体中的疗效和安全性（平均随访 26.9 个月）。客观治愈率的荟萃分析显示，在总体患者中，经耻骨后与经闭孔无张力阴道吊带相比，具有显著优势（OR 3.37，95%CI 2.55-4.43，p<0.00001，I = 37%），且在每个亚人群中均如此。在总体患者中，经耻骨后无张力阴道吊带的主观治愈率也显著优于经闭孔无张力阴道吊带（OR 2.01，95%CI 1.45-2.80，p<0.0001，I = 0%），且在固有括约肌缺陷和经尿道中段吊带置入后复发性压力性尿失禁患者中也如此。耻骨后与经闭孔无张力阴道吊带的总体并发症无显著差异（OR 1.22，95%CI 0.89-1.66，p = 0.21，I = 0%）。
荟萃分析显示，在经尿道中段吊带置入后肥胖、固有括约肌缺陷、盆腔器官脱垂和复发性压力性尿失禁患者中，经耻骨后无张力阴道吊带在客观和主观治愈率方面优于经闭孔无张力阴道吊带。耻骨后无张力阴道吊带的发病率与经闭孔无张力阴道吊带相当。
