A systematic review and meta-analysis of single-incision mini-slings (MiniArc) versus transobturator mid-urethral slings in surgical management of female stress urinary incontinence

Binbin Jiao, Shicong Lai, Xin Xu, Meng Zhang, Tongxiang Diao, Guan Zhang, Binbin Jiao, Shicong Lai, Xin Xu, Meng Zhang, Tongxiang Diao, Guan Zhang

Abstract

Background: To assess the current evidence of effectiveness and safety of single-incision mini-slings (MiniArc) versus transobturator midurethral slings in the management of female stress urinary incontinence (SUI).

Methods: A systematic search was performed from the electronic databases including PubMed, EMBASE, and Cochrane Library by November 2017. Using RevMan5.3 statistical software, the primary outcomes including subject and objective cure rates at 6 to 24 months follow-up were evaluated. Meanwhile, analysis was also performed for comparing the secondary outcomes such as peri- and postoperative complications, operative data, and quality of life.

Results: Six randomized controlled trials (RCTs) and 6 retrospective cohort studies involving 1794 patients with SUI were analyzed based on the inclusion criteria. On the basis of our analysis, MiniArc was proven to have a noninferior clinical efficacy compared with transobturator midurethral slings with respect to the objective cure rate (risk ratio [RR] = 0.98, 95% confidence interval [CI] 0.94-1.03, P = .43) and subjective cure rate (RR = 0.97, 95% CI 0.91-1. 04, P = .38). In addition, pooled analysis showed that MiniArc had significantly lower postoperative pain scores (mean difference [MD] = -1.70, 95% CI -3.17 to -0.23, P = .02) and less postoperative groin pain (RR = 0.42, 95% CI 0.18-0.98, P = .04). Moreover, the MiniArc group also had a significantly shorter operation time (MD = -6.12, 95% CI -8.61 to -3.64, P < .001), less blood loss (MD = -16.67, 95% CI -26.29 to -7.05, P < .001), shorter in-patient stay (MD = 1.30, 95% CI -1.74 to -0.86, P < .001), and less urinary retention risk (RR = 1.15, 95% CI 0.46-2.87, P = .77). However, overall evidence was insufficient to suggest a statistically significant difference in the adverse event profile for MiniArc compared with transobturator slings.

Conclusions: This meta-analysis indicates that MiniArc is an effective method treating SUI. When compared with transobturator slings, it not only has a similar high cure rates, but also is associated with shorter operation time, less blood loss, more favorable recovery time, lower postoperative pain scores, less postoperative groin pain, less urinary retention, and absence of a visible wound. However, the findings of this study should be further confirmed by well-designed prospective RCTs with a larger patient series.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analysis flowchart.
Figure 2
Figure 2
(A) Forest plot of the subjective cure rate. (B) Forest plot of the objective cure rate. 95% CI = 95% confidence interval, df = degrees of freedom, Fixed = fixed effects model, IV = inverse variance, SD = standard deviation.
Figure 3
Figure 3
(A) Forest plot of the operation time. (B) Forest plot of the sensitivity analysis of the operation time. 95% CI = 95% confidence interval, df = degrees of freedom, IV = inverse variance, Random = random-effects model, SD = standard deviation.
Figure 4
Figure 4
(A) Forest plot of the blood loss. (B) Forest plot of the sensitivity analysis of the blood loss. 95% CI = 95% confidence interval, df = degrees of freedom, IV = inverse variance, Random = random-effects model, SD = standard deviation.
Figure 5
Figure 5
Forest plot of the hospitalization time. 95% CI = 95% confidence interval, df = degrees of freedom, IV = inverse variance, Random = random-effects model, SD = standard deviation.
Figure 6
Figure 6
(A) Forest plot of the postoperative pain. (B) Forest plot of the sensitivity analysis of the postoperative pain or discomfort. 95% CI = 95% confidence interval, df = degrees of freedom, IV = inverse variance, Random = random-effects model, SD = standard deviation.
Figure 7
Figure 7
Forest plot of the postoperative groin pain. 95% CI = 95% confidence interval, df = degrees of freedom, IV = inverse variance, Random = random-effects model, SD = standard deviation.
Figure 8
Figure 8
Forest plot of the urinary retention. 95% CI = 95% confidence interval, df = degrees of freedom, IV = inverse variance, Random = random-effects model, SD = standard deviation.
Figure 9
Figure 9
Forest plot of the repeat stress incontinence surgery. 95% CI = 95% confidence interval, df = degrees of freedom, IV = inverse variance, Random = random-effects model, SD = standard deviation.
Figure 10
Figure 10
Forest plot of the bladder perforation. 95% CI = 95% confidence interval, df = degrees of freedom, Fixed = fixed-effects model, IV = inverse variance, SD = standard deviation.
Figure 11
Figure 11
Forest plot of the de novo urgency. 95% CI = 95% confidence interval, df = degrees of freedom, IV = inverse variance, Random = random-effects model, SD = standard deviation.
Figure 12
Figure 12
Forest plot of the urinary tract infection. 95% CI = 95% confidence interval, df = degrees of freedom, IV = inverse variance, Random = random-effects model, SD = standard deviation.
Figure 13
Figure 13
Forest plot of the vaginal mesh erosion. 95% CI = 95% confidence interval, df = degrees of freedom, Fixed = fixed-effects model, IV = inverse variance, SD = standard deviation.
Figure 14
Figure 14
Forest plot of the sexual function. 95% CI = 95% confidence interval, df = degrees of freedom, Fixed = fixed-effects model, IV = inverse variance, SD = standard deviation.

References

    1. Hogewoning CR, Ruhe IM, Bekker MD, et al. The MiniArc sling for female stress urinary incontinence: clinical results after 1-year follow-up. Int Urogynecol J 2012;23:589–95.
    1. Maral I, Ozkardeş H, Peşkircioğlu L, et al. Prevalence of stress urinary incontinence in both sexes at or after age 15 years: a cross-sectional study. J Urol 2001;165:408–12.
    1. Nambiar A, Cody JD, Jeffery ST. Single-incision sling operations for urinary incontinence in women. Cochrane Database Syst Rev 2014;7:CD008709.
    1. Mostafa A, Agur W, Abdel-All M, et al. A multicentre prospective randomised study of single-incision mini-sling (Ajust®) versus tension-free vaginal tape-obturator (TVT-O™) in the management of female stress urinary incontinence: pain profile and short-term outcomes. Eur J Obstet Gynecol Reprod Biol 2012;165:115–21.
    1. Beyar N, Groutz A. Pelvic floor muscle training for female stress urinary incontinence: five years outcomes. Neurourol Urodyn 2017;36:132–5.
    1. Glazener CM, Cooper K, Mashayekhi A. Bladder neck needle suspension for urinary incontinence in women. Cochrane Database Syst Rev 2017;7:CD003636.
    1. Glazener CM, Cooper K, Mashayekhi A. Anterior vaginal repair for urinary incontinence in women. Cochrane Database Syst Rev 2017;7:CD001755.
    1. Cormio L, Mancini V, Liuzzi G, et al. Surgical management of female pelvic organ prolapse with and without urinary incontinence: a single center experience. Medicine (Baltimore) 2017;96:e7914.
    1. Meschia M, Barbacini P, Ambrogi V, et al. TVT-Secur: a minimally invasive procedure for the treatment of primary stress urinary incontinence. One year data from a multicentre prospective trial. Int Urogynecol J Pelvic Floor Dysfunct 2009;20:313–7.
    1. Lim JL, De Cuyper EM, Cornish A, et al. Short-term clinical and quality-of-life outcomes in women treated by the TVT-Secur procedure. Aust N Z J Obstet Gynaecol 2010;50:168–72.
    1. Cornu J-N, Sèbe P, Peyrat L, et al. Midterm prospective evaluation of TVT-Secur reveals high failure rate. Eur Urol 2010;58:157–61.
    1. Lee SW, Cho WJ, Lee HN, et al. Three-year follow-up results of TVT-Secur operation for management of female stress urinary incontinence. J Urol 2012;187suppl 1:e213.
    1. Levi A, Nasra R, Shachar IB, et al. Medium-term results of Mini-arc for urinary stress incontinence in ambulatory patients under local anesthesia. Int Braz J Urol 2016;42:1195–201.
    1. Kennelly MJ, Moore R, Nguyen JN, et al. Miniarc single-incision sling for treatment of stress urinary incontinence: 2-year clinical outcomes. Int Urogynecol J 2012;23:1285–91.
    1. Mostafa A, Agur W, Abdel-All M, et al. Oxford Centre for Evidence-based Medicine—Levels of Evidence; 2009. Available from: Accessed May 2016.
    1. Clark HD, Wells GA, Huët C, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials 1999;20:448–52.
    1. Wells GA, Shea B, O’Connell, et al. The Newcastle Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta analyses. Ottawa Hospital Research Institute. Available from: Accessed May 2016.
    1. Tutolo M, De Ridder DJ, Montorsi F, et al. A minimum of 1-year follow-up for MiniArc single incision slings compared to Monarc transobturator slings: an analysis to evaluate durability of continence and medium-term outcomes. Neurourol Urodyn 2017;36:803–7.
    1. Schellart RP, Oude Rengerink K, Van der Aa F, et al. A randomized comparison of a single-incision midurethral sling and a transobturator midurethral sling in women with stress urinary incontinence: results of 12-mo follow-up. Eur Urol 2014;66:1179–85.
    1. Foote A. Randomized prospective study comparing Monarc and MiniArc suburethral slings. J Obstet Gynaecol Res 2015;41:127–31.
    1. Lee JK, Rosamilia A, Dwyer PL, et al. Randomized trial of a single incision versus an outside-in transobturator midurethral sling in women with stress urinary incontinence: 12 month results. Am J Obstet Gynecol 2015;213:35.e1–9.
    1. Tieu AL, Hegde A, Castillo PA, et al. Transobturator versus single incision slings: 1-year results of a randomized controlled trial. Int Urogynecol J 2017;28:461–7.
    1. Lo TS, Tan YL, Wu PY, et al. Ultrasonography and clinical outcomes following surgical anti-incontinence procedures (Monarc vs MiniArc). Eur J Obstet Gynecol Reprod Biol 2014;182:91–7.
    1. Enzelsberger H, Cemer I, Enzelsberger S, et al. MiniArc1 versus Monarc1—a prospective randomized study of the treatment of female stress urinary incontinence with a follow-up of 2 years [in German]. Geburtsh Frauenheilk 2010;70:499–502.
    1. De Ridder D, Berkers J, Deprest J, et al. Single incision mini-sling versus a transobturator sling: a comparative study on MiniArc™ and Monarc™ slings. Int Urogynecol J 2010;21:773–8.
    1. Castroviejo-Royo F, Martinez-Sagarra-Oceja JM, Marina-García-Tuñón C, et al. Treatment of female stress urinary incontinence using suburethral slings: comparative, retrospective, observational study of two surgical techniques. Actas Urol Esp 2013;37:549–53.
    1. Sun MJ, Sun R, Li YI. A comparative study of a single-incision sling and a transobturator sling: clinical efficacy and urodynamic changes. Int Urogynecol J 2013;24:823–9.
    1. Oliveira R, Botelho F, Silva P, et al. Exploratory study assessing efficacy and complications of TVT-O, TVT-Secur, and Mini-Arc: results at 12-month follow-up. Eur Urol 2011;59:940–4.
    1. Wu LY, Yang TH, Kung FT, et al. Comparison of the clinical outcomes of transobturator and single-incision slings for stress urinary incontinence. Kaohsiung J Med Sci 2016;32:367–72.
    1. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13.
    1. Fan YJ, Huang ZH, Yu DX. Incontinence-specific quality of life measures used in trials of sling procedures for female stress urinary incontinence: a meta-analysis. Int Urol Nephrol 2015;47:1277–95.
    1. Hay-smith J, Herderschee R, Dumoulin C, et al. Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women: an abridged Cochrane systematic review. Eur J Phys Rehabil Med 2012;48:689–705.
    1. Ulmsten U, Petros P. Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 1995;29:75–82.
    1. Deng DY, Rutman M, Raz S, et al. Presentation and management of major complications of midurethral slings: are complications under-reported. Neurourol Urodyn 2007;26:46–52.
    1. Delorme E, Droupy S, De Tayrac R, et al. Transobturator Tape (UratapeW): a new minimally-invasive procedure to treat female urinary incontinence. Eur Urol 2004;45:203–7.
    1. Delorme E. Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women. Prog Urol 2001;11:1306–13.
    1. De Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 2003;44:724–30.
    1. Fusco F, Abdel-Fattah M, Chapple CR, et al. Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings, and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol 2017;72:567–91.
    1. Bianchi-Ferraro AM, Jarmy-DiBella ZI, De Aquino Castro R, et al. Randomized controlled trial comparing TVT-O and TVT-S for the treatment of stress urinary incontinence: 2-year results. Int Urogynecol J 2014;25:1343–8.
    1. Moore RD, Serels SR, Davila GW, et al. Minimally invasive treatment for female stress urinary incontinence (SUI): a review including TVT, TOT, and mini-sling. Surg Technol Int 2009;18:157–73.
    1. Abdel-Fattah M, Ford JA, Lim CP, et al. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: a meta-analysis of effectiveness and complications. Eur Urol 2011;60:468–80.
    1. Kocjancic E, Sedlar A. A strength comparison of immediate and delayed extraction forces of 5 different single incision slings anchor types: an animal model. Int Urogynaecol J 2012;2suppl 2:S115.
    1. Basu M, Duckett J. A randomised trial of a retropubic tension-free vaginal tape versus a mini-sling for stress incontinence. BJOG 2010;117:730–5.
    1. Oliveira R, Silva A, Pinto R, et al. Short-term assessment of a tension-free vaginal tape for treating female stress urinary incontinence. BJU Int 2009;104:225–8.
    1. Hinoul P, Vanormelingen L, Roovers J-P, et al. Anatomical variability in the trajectory of the inside-out transobturator vaginal tape technique (TVT-O). Int Urogynecol J Pelvic Floor Dysfunct 2007;18:1201–6.
    1. Kennelly MJ, Moore R, Nguyen JN, et al. Prospective evaluation of a single incision sling for stress urinary incontinence. J Urol 2010;184:604–9.
    1. Boyers D, Kilonzo M, Mostafa A, et al. Comparison of an adjustable anchored single-incision mini-sling, Ajust, with a standard mid-urethral sling, TVT-O: a health economic evaluation. BJU Int 2013;112:1169–77.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever