Key messages from scientific research that's ready to be acted on
Got It, Hide thisSchimpf MO, Rahn DD, Wheeler TL, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211:71.e1-71.e27.
In women who have stress urinary incontinence, how do slings and the Burch urethropexy compare for improving symptoms?
Stress urinary incontinence is the involuntary leakage of urine during movements and activities such as sneezing and coughing. Stress incontinence in women can be caused by several factors, including menstruation, menopause, pregnancy, childbirth, and surgery.
Burch urethropexy and pubovaginal slings are traditional surgical treatments for stress urinary incontinence. Midurethral slings have been used more commonly in the past 20 years.
The researchers did a systematic review, based on studies available up to April 2013.
They found 49 randomized controlled trials.
The key features of the trials were:
Compared with Burch urethropexy, midurethral slings were better for perioperative outcomes but not different for objective cure, subjective cure, quality of life, or sexual functioning.
Compared with Burch urethropexy, pubovaginal slings were better for objective and subjective cures, poorer for perioperative outcomes, and not different for quality of life.
Retropubic and obturator slings did not differ for objective or subjective cures, perioperative outcomes, quality of life, or sexual functioning.
There was no moderate or high strength evidence to support comparisons of midurethral and pubovaginal slings.
In women who have stress urinary incontinence, midurethral or pubovaginal slings are better or no different than the Burch urethropexy for improving symptoms.
Comparisons | Objective cure | Subjective cure | Perioperative outcomes | Quality of life |
Midurethral sling vs Burch urethropexy | No difference (9 trials, 994 women, moderate-strength evidence) | No difference (8 trials, 712 women, moderate-strength evidence) | Better with sling (9 trials, 964 women, high-strength evidence) | No difference (3 trials, 465 women, moderate-strength evidence) |
Pubovaginal sling vs Burch urethropexy | Better with sling (4 trials, 855 women, high-strength evidence) | Better with sling (2 trials, 747 women, high-strength evidence) | Better with Burch (3 trials, 819 women, high-strength evidence) | No difference (1 trial, 655 women, high-strength evidence) |
Retropubic sling vs obturator sling | No difference (19 trials, 3354 women, high-strength evidence) | No difference (18 trials, 3186 women, high-strength evidence) | No difference for most outcomes (21 trials, 3811 women, high-strength evidence) | No difference (15 trials, 2837 women, high-strength evidence) |