To evaluate the efficacy and safety of single-incision mini-sling for stress urinary incontinence based on network Meta-analysis.
We searched PubMed, Embase, and Cochrane libraries from August 2008 to August 2019. Randomized controlled trials comparing two or more indicators of Miniarc (Single Incision Mini-slings), Ajust (Adjustable Single-Incision Sling), C-NDL (Contasure-Needleless), TFS (Tissue Fixation System), Ophria (Transobturator Vaginal Tap), TVT-O (Transobturator Vaginal Tape), and TOT (Trans-obturatortape) in treating female stress urinary incontinence were collected.
Totally, 3,428 patients from 21 studies were included. Ajust had the highest subjective cure rate (Rank=0.52), while Ophira had the worst (Rank=0.67). TFS had the highest objective cure rate, and the worst was found in Ophira. TFS required the shortest operating time (Rank=0.40), while TVT-O required the longest operating time (Rank=0.47). Miniarc had the least bleeding (Rank=0.47), while TVT-O had the most bleeding (Rank=0.37). C-NDL had the shortest postoperative hospital stay (Rank=0.77), while Ajust had the longest postoperative hospital stay (Rank=0.36). For postoperative complications, TFS performed best in groin pain (Rank=0.84), urinary retention (Rank=0.78), and repeat surgery (Rank=0.45). TVT-O performed worst in groin pain (Rank=0.36), and urinary retention (Rank=0.58). Miniarc had the highest repeat surgery rate (Rank=0.35). Ajust had the lowest probability of tap erosion (Rank=0.30), while Ophira had the highest tap erosion level (Rank=0.45). Miniarc showed the greatest advantage in urinary tract infections (Rank=0.84) and de novo urgency (Rank=0.60), while C-NDL had the highest incidence of urethral infections (Rank=0.51). Ophira performed worst in de novo urgency (Rank=0.60). C-NDL performed the best in sexual intercourse pain (Rank=0.79) while Ajust was the worst (Rank=0.49).
In view of comprehensive efficacy and safety, we recommend that TFS or Ajust should be selected first for single-incision sling and the application of Ophria should be minimized.
Urology journal. 2023 Mar 11 [Epub ahead of print]
Yuxin Chen, Jiecheng Zhang, Yankai Zeng, Weidong Chen, Fei Liu, Jinchun Xing, Bili Zhang, Yuedong Chen
Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen 361003, China. ., Department of Urology, Dehua Affiliated Hospital of Huaqiao University, Fujian 362500, China. ., Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen 361003, China. ., Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen 361003, China. ., Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen 361003, China. ., Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen 361003, China. ., Department of Obstetrics, Xiamen Maternity and Child Health Care Hospital, Xiamen 361003, China. ., Department of Urology, First Affiliated Hospital of Xiamen University, Xiamen 361003, China. .