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Evidence Summary

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In women with stress urinary incontinence, midurethral or pubovaginal slings are better or no different than the Burch urethropexy for improving symptoms

Schimpf MO, Rahn DD, Wheeler TL, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211:71.e1-71.e27.

Review question

In women who have stress urinary incontinence, how do slings and the Burch urethropexy compare for improving symptoms?

Background

Stress urinary incontinence is the involuntary leakage of urine during movements and activities such as sneezing and coughing. Stress incontinence in women can be caused by several factors, including menstruation, menopause, pregnancy, childbirth, and surgery.

Burch urethropexy and pubovaginal slings are traditional surgical treatments for stress urinary incontinence. Midurethral slings have been used more commonly in the past 20 years.

How the review was done

The researchers did a systematic review, based on studies available up to April 2013.

They found 49 randomized controlled trials.

The key features of the trials were:

  • women had stress urinary incontinence;
  • treatments included midurethral slings, pubovaginal slings, and Burch urethropexy;
  • follow-up ranged from 12 months to 73 months; and
  • outcomes included objective cure (cough stress test, pad testing, urodynamic stress incontinence, and voiding diary data), subjective cure (including incontinence questionnaires and satisfaction measures), perioperative measures (including length of hospital stay and operative time), quality of life, and sexual functioning.

What the researchers found

Compared with Burch urethropexy, midurethral slings were better for perioperative outcomes but not different for objective cure, subjective cure, quality of life, or sexual functioning.

Compared with Burch urethropexy, pubovaginal slings were better for objective and subjective cures, poorer for perioperative outcomes, and not different for quality of life.

Retropubic and obturator slings did not differ for objective or subjective cures, perioperative outcomes, quality of life, or sexual functioning.

There was no moderate or high strength evidence to support comparisons of midurethral and pubovaginal slings.

Conclusions

In women who have stress urinary incontinence, midurethral or pubovaginal slings are better or no different than the Burch urethropexy for improving symptoms.

Treatments for stress urinary incontinence in women*

Comparisons

Objective cure

Subjective cure

Perioperative outcomes

Quality of life

Midurethral sling vs Burch urethropexy

No difference (9 trials, 994 women, moderate-strength evidence)

No difference (8 trials, 712 women, moderate-strength evidence)

Better with sling (9 trials, 964 women, high-strength evidence)

No difference (3 trials, 465 women, moderate-strength evidence)

Pubovaginal sling vs Burch urethropexy

Better with sling (4 trials, 855 women, high-strength evidence)

Better with sling (2 trials, 747 women, high-strength evidence)

Better with Burch (3 trials, 819 women, high-strength evidence)

No difference (1 trial, 655 women, high-strength evidence)

Retropubic sling vs obturator sling

No difference (19 trials, 3354 women, high-strength evidence)

No difference (18 trials, 3186 women, high-strength evidence)

No difference for most outcomes  (21 trials, 3811 women, high-strength evidence)

No difference (15 trials, 2837 women, high-strength evidence)

*Comparisons with moderate- or high-strength evidence are reported here.

 




Glossary

Perioperative
Before, during, or after surgery.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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