The efficacy and safety comparison of surgical treatments for stress urinary incontinence: A network meta-analysis
Pan Song
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorYibo Wen
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorCorresponding Author
Chuiguo Huang
Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Correspondence
Jianguo Wen, PhD, Department of Urodynamic Centre and Urology, the first affiliated hospital of Zhengzhou University, Jianshe road No.1, Zhengzhou city, 450000, China.
Email: [email protected]
Chuiguo Huang, MD, Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Jingba road, Zhengzhou, 450014 China.
Email: [email protected]
Search for more papers by this authorWancong Wang
Department of Digestion, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorNaijun Yuan
The College of Traditional Chinese Medicine of Jinan University, Institute of Integrated Traditional Chinese and Western Medicine of Jinan University, Guangzhou, Guangdong Province, China
Search for more papers by this authorYinliang Lu
Department of Radiotherapy, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
Search for more papers by this authorQingwei Wang
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorTao Zhang
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorCorresponding Author
Jianguo Wen
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Correspondence
Jianguo Wen, PhD, Department of Urodynamic Centre and Urology, the first affiliated hospital of Zhengzhou University, Jianshe road No.1, Zhengzhou city, 450000, China.
Email: [email protected]
Chuiguo Huang, MD, Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Jingba road, Zhengzhou, 450014 China.
Email: [email protected]
Search for more papers by this authorPan Song
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorYibo Wen
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorCorresponding Author
Chuiguo Huang
Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Correspondence
Jianguo Wen, PhD, Department of Urodynamic Centre and Urology, the first affiliated hospital of Zhengzhou University, Jianshe road No.1, Zhengzhou city, 450000, China.
Email: [email protected]
Chuiguo Huang, MD, Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Jingba road, Zhengzhou, 450014 China.
Email: [email protected]
Search for more papers by this authorWancong Wang
Department of Digestion, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorNaijun Yuan
The College of Traditional Chinese Medicine of Jinan University, Institute of Integrated Traditional Chinese and Western Medicine of Jinan University, Guangzhou, Guangdong Province, China
Search for more papers by this authorYinliang Lu
Department of Radiotherapy, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
Search for more papers by this authorQingwei Wang
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorTao Zhang
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Search for more papers by this authorCorresponding Author
Jianguo Wen
Department of Urodynamic Centre and Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
Correspondence
Jianguo Wen, PhD, Department of Urodynamic Centre and Urology, the first affiliated hospital of Zhengzhou University, Jianshe road No.1, Zhengzhou city, 450000, China.
Email: [email protected]
Chuiguo Huang, MD, Department of Urology, The Second Affiliated Hospital of Zhengzhou University, Jingba road, Zhengzhou, 450014 China.
Email: [email protected]
Search for more papers by this authorAbstract
Aims
Stress urinary incontinence (SUI) is a common problem worldwide. Mainstream surgical procedures include tension-free vaginal tape (TVT), transobturator tape (TOT), tension-free vaginal tape-obturator (TVT-O), tension-free vaginal tape SECUR (TVT-S), and adjustable single-incision sling (Ajust). The aim of this study was to compare the efficacy and safety of these surgical procedures and assess which surgery is most optimal for SUI by adopting a network meta-analysis (NMA).
Methods
Electronic databases including PubMed, Cochrance Library, and Embase database were researched systematically, until March 21, 2017. The randomized controlled trials (RCTs) that compared the efficacy and safety of TVT, TOT, TVT-O, TVT-S, and Ajust were identified. The studies were included in the analysis when met the predefined inclusion criteria. After demographic and outcome data extraction, a network meta-analysis was conducted with software R 3.3.2 and STATA 14.0. Objective cure rate, subjective cure rate, postoperative complication rate, bladder perforation, tape erosion, urinary retention, and postoperative pain were considered as outcomes, and the outcomes were displayed as odds ratios (ORs) and 95% credible intervals (CrI). The consistency of direct and indirect evidence was assessed by node splitting. The ranks based on probabilities of intervention for the different endpoints were performed.
Results
Fourty-five RCTs with 7295 participants were analyzed. The NMA results revealed that, TVT, TOT, and Ajust had a higher objective cure rate than TVT-O and TVT-S (TVT-O: OR = 0.76, 95%CI [0.61, 0.94]; TVT-S: OR = 0.41, 95%CI [0.28, 0.60]). TVT, TOT, and TVT-O had a superior subjective cure rate than TVT-S and Ajust (Ajust: OR = 0.45, 95%CI [0.20, 0.91]; TVT-S: OR = 0.29, 95%CI [0.15, 0.56]). With TVT as the reference, TVT-S had a statistically lower postoperative complication rate (TVT-S: OR = 0.39, 95%CI [0.16, 0.89]). TVT-O, TVT-S, and TOT had a significantly lower bladder perforation rate (TOT: OR = 0.076, 95%CI [0.0060, 0.37]; TVT-O: OR = 4.1e-17, 95%CI [6.1e-48, 0.0032]; TVT-S: OR = 3.8e-17, 95%CI [1.8e-48, 0.0052]). There were no obvious differences between the five treatments for tape erosion. TVT-O exhibited a less postoperative retention (TVT-O: OR = 0.35, 95%CI [0.16, 0.74]). Probabilities of ranking results indicated that TOT was the treatment with best ranking in efficacy and a relatively high safety.
Conclusions
Our study recommend TOT as the optimal regimen for SUI with high efficacy and moderate safety when compared with TVT, TVT-O, TVT-S, and Ajust interventions. However, with the limitation of our study, additional high-quality studies are needed to further evaluate the outcomes.
CONFLICTS OF INTEREST
The authors have no competing interests.
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