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

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.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-analysis flowchart.

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

(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

(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

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

(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

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

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

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

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

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

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

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

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.