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Meta-Analysis
. 2017 Jul 31;7(7):CD001755.
doi: 10.1002/14651858.CD001755.pub2.

Anterior vaginal repair for urinary incontinence in women

Cathryn Ma Glazener  1 , Kevin Cooper, Atefeh Mashayekhi
Affiliations
Meta-Analysis

Anterior vaginal repair for urinary incontinence in women

Cathryn Ma Glazener et al. Cochrane Database Syst Rev. .

Abstract

Background: Anterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence (SUI) in women. About a third of adult women experience urinary incontinence. SUI imposes significant health and economic burden to the society and the women affected.

Objectives: To determine the effects of anterior vaginal repair (anterior colporrhaphy) on urinary incontinence in comparison with other management options.

Search methods: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 September 2009) and the reference lists of relevant articles.

Selection criteria: Randomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence.

Data collection and analysis: Two review authors independently extracted data and assessed trial quality. Three trial investigators were contacted for additional information.

Main results: Ten trials were identified which included 385 women having an anterior vaginal repair and 627 who received comparison interventions.A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with bladder neck needle suspension appeared similar (risk ratio (RR) for failure after one year 1.16, 95% confidence interval (CI) 0.86 to 1.56), but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic colposuspensions, or compared alternative vaginal operations.Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the medium term (failure rate within one to five years after anterior repair 97/259 (38%) versus 57/327 (17%); RR 2.29, 95% confidence Interval (CI) 1.70 to 3.08) and in the long term (after five years, (49/128 (38%) versus 31/145 (21%); RR 2.02, 95% CI 1.36 to 3.01). There was evidence from three of these trials that this was reflected in a need for more repeat operations for incontinence (25/107 (23%) versus 4/164 (2%); RR 8.87, 95% CI 3.28 to 23.94). These findings held, irrespective of the co-existence of prolapse (pelvic relaxation). Although fewer women had a prolapse after anterior repair (RR 0.24, 95% CI 0.12 to 0.47), later prolapse operation appeared to be equally common after vaginal (3%) or abdominal (4%) operation.In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension.

Authors' conclusions: There were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about postoperative complications and morbidity.A Brief Economic Commentary (BEC) identified one study suggesting that vaginoplasty may be more cost-effective compared with tension-free vaginal tape (TVT-O).

PubMed Disclaimer

Conflict of interest statement

Cathryn MA Glazener: None known.

Kevin Cooper: No grants held which are connected with the subject of the Cochrane review. All grants peer reviewed and independently funded.

Atefeh Mashayekhi: This project, to add Brief Economic Commentaries to our surgery for UI in women reviews, was supported by the National Institute for Health Research (NIHR), via the Cochrane Review Incentive Scheme 2016, to the Cochrane Incontinence Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Figures

2.1
2.1. Analysis
Comparison 2 ANTERIOR REPAIR VS PELVIC FLOOR MUSCLE TRAINING, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
2.2
2.2. Analysis
Comparison 2 ANTERIOR REPAIR VS PELVIC FLOOR MUSCLE TRAINING, Outcome 2 Number not improved (worse or unchanged) within first year.
2.3
2.3. Analysis
Comparison 2 ANTERIOR REPAIR VS PELVIC FLOOR MUSCLE TRAINING, Outcome 3 Number not improved (worse or unchanged) after first year.
3.1
3.1. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
3.2
3.2. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 2 Number not cured (worse, unchanged or improved) within 1 to 5 years.
3.3
3.3. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 3 Number not cured (worse, unchanged or improved) after 5 years.
3.4
3.4. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 4 Urge symptoms or urge incontinence.
3.5
3.5. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 5 Pad test weights.
3.6
3.6. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 6 Health status measures.
3.7
3.7. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 7 Voiding dysfunction after 3 months.
3.8
3.8. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 8 Detrusor instability (objective diagnosis by urodynamics).
3.9
3.9. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 9 Perioperative surgical complications.
3.10
3.10. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 10 Time of operation (minutes).
3.11
3.11. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 11 Time to catheter removal.
3.12
3.12. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 12 Length of inpatient stay.
3.13
3.13. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 13 New or persistent prolapse.
3.14
3.14. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 14 Repeat incontinence surgery.
3.15
3.15. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 15 Later prolapse surgery.
3.16
3.16. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 16 Death.
3.17
3.17. Analysis
Comparison 3 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION, Outcome 17 Dyspareunia.
4.1
4.1. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 1 Number not cured (worse, unchanged or improved) within first year.
4.2
4.2. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 2 Number not cured (worse, unchanged or improved) within 1 to 5 years.
4.3
4.3. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 3 Number not cured (worse, unchanged or improved) after 5 years.
4.4
4.4. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 4 Urge symptoms or urge incontinence.
4.5
4.5. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 5 Health status measures.
4.6
4.6. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 6 Voiding dysfunction after 3 months.
4.7
4.7. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 7 Detrusor instability (objective diagnosis by urodynamics).
4.8
4.8. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 8 New or persistent prolapse.
4.9
4.9. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 9 Perioperative surgical complications.
4.10
4.10. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 10 Length of inpatient stay.
4.11
4.11. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 11 Repeat incontinence surgery.
4.12
4.12. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 12 Later prolapse surgery.
4.13
4.13. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 13 Death.
4.14
4.14. Analysis
Comparison 4 ANTERIOR REPAIR VS OPEN ABDOMINAL RETROPUBIC SUSPENSION (FOR INCONTINENCE WITH PROLAPSE), Outcome 14 Dyspareunia.
5.1
5.1. Analysis
Comparison 5 ANTERIOR REPAIR VS NEEDLE SUSPENSION, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
5.2
5.2. Analysis
Comparison 5 ANTERIOR REPAIR VS NEEDLE SUSPENSION, Outcome 2 Number not cured (worse, unchanged or improved) after first year.
5.3
5.3. Analysis
Comparison 5 ANTERIOR REPAIR VS NEEDLE SUSPENSION, Outcome 3 Urge symptoms or urge incontinence.
5.4
5.4. Analysis
Comparison 5 ANTERIOR REPAIR VS NEEDLE SUSPENSION, Outcome 4 Perioperative surgical complications.
5.5
5.5. Analysis
Comparison 5 ANTERIOR REPAIR VS NEEDLE SUSPENSION, Outcome 5 New or persistent prolapse.
5.6
5.6. Analysis
Comparison 5 ANTERIOR REPAIR VS NEEDLE SUSPENSION, Outcome 6 Voiding dysfunction after 3 months.
See this image and copyright information in PMC

Update of

References

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References to studies excluded from this review

Bump 1996 {published data only}
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Park 1988 {published data only}
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References to other published versions of this review

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