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For stubborn stress urinary incontinence, try midurethral tapes first: meta-analysis

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) For surgical management of female stress urinary incontinence, tension-free midurethral tapes should be “the first option of treatment,” according to the lead author of a recent meta-analysis update.

“In the selection between retropubic and transobdurator tension-free midurethral tapes, the two procedures seem to have similar outcomes but transobdurator tapes are followed by lower risk of intraoperative complications,” Dr. Giacomo Novara from the Urology Clinic, University of Padua, Italy, told Reuters Health by email.

“Transobdurator tapes will be used more and more,” he predicted, “whereas the use of retropubic tapes might be limited to specific conditions (such as) intrinsic sphincter deficiency, where at least a randomized controlled trial and several non-randomized comparative studies suggest their better results.”

In a paper published online April 23rd in European Urology, Dr. Novara and colleagues report a systematic review and meta-analysis of comparative data on the use of colposuspensions, pubovaginal slings, and midurethral tapes in women with stress urinary incontinence. Using Medline, Embase, Scopus, Web of Science databases, and Cochrane Database of Systematic Reviews, they selected 39 randomized controlled trials for inclusion in their analyses.

According to their report, women treated with midurethral tapes had significantly higher overall cure rates (odds ratio: 0.61) and objective cure rates (OR: 0.38) as determined by a cough test — compared to women treated with Burch colposuspension and pubovaginal slings. However, the risk of bladder perforations was greater with midurethral tapes (OR: 4.94).

Patients treated with midurethral tapes and pubovaginal slings had similar cure rates, the team found, although the latter were slightly more likely to experience storage lower urinary tract symptoms (OR: 0.31) and had a higher reoperation rate (OR: 0.31).

Patients treated with retropubic tape had slightly higher objective cure rates (OR: 0.8) than those treated with transobdurator tape. Subjective cure rates were similar, however, and patients treated with transobdurator tape had a much lower risk of bladder and vaginal perforations (OR: 2.5), hematoma (OR: 2.62), and storage lower urinary tract symptoms (OR: 1.35).