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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 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).
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29620645
OWN - NLM
STAT- MEDLINE
DCOM- 20180416
LR  - 20180416
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 14
DP  - 2018 Apr
TI  - 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.
PG  - e0283
LID - 10.1097/MD.0000000000010283 [doi]
AB  - 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.
FAU - Jiao, Binbin
AU  - Jiao B
AD  - Peking University China-Japan Friendship School of Clinical Medicine.
AD  - Department of Urology, China-Japan Friendship Hospital, Chaoyang.
FAU - Lai, Shicong
AU  - Lai S
AD  - Peking University China-Japan Friendship School of Clinical Medicine.
AD  - Department of Urology, China-Japan Friendship Hospital, Chaoyang.
FAU - Xu, Xin
AU  - Xu X
AD  - Peking University China-Japan Friendship School of Clinical Medicine.
FAU - Zhang, Meng
AU  - Zhang M
AD  - Peking University China-Japan Friendship School of Clinical Medicine.
AD  - Department of Urology, China-Japan Friendship Hospital, Chaoyang.
FAU - Diao, Tongxiang
AU  - Diao T
AD  - Peking University Fifth School of Clinical Medicine.
AD  - Department of Urology, Beijing Hospital, Dongcheng, Beijing, China.
FAU - Zhang, Guan
AU  - Zhang G
AD  - Peking University China-Japan Friendship School of Clinical Medicine.
AD  - Department of Urology, China-Japan Friendship Hospital, Chaoyang.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Obturator Nerve/surgery
MH  - Operative Time
MH  - Pain, Postoperative/etiology
MH  - Postoperative Complications/*etiology
MH  - Postoperative Period
MH  - Prosthesis Implantation/*adverse effects/methods
MH  - Quality of Life
MH  - Suburethral Slings/*adverse effects
MH  - Surgical Wound
MH  - Treatment Outcome
MH  - Urinary Incontinence, Stress/*surgery
MH  - Urinary Retention/etiology
EDAT- 2018/04/06 06:00
MHDA- 2018/04/17 06:00
CRDT- 2018/04/06 06:00
PHST- 2018/04/06 06:00 [entrez]
PHST- 2018/04/06 06:00 [pubmed]
PHST- 2018/04/17 06:00 [medline]
AID - 10.1097/MD.0000000000010283 [doi]
AID - 00005792-201804060-00023 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Apr;97(14):e0283. doi: 10.1097/MD.0000000000010283.