Näytönastekatsaukset

Mid-urethral sling operations for stress urinary incontinence

Näytönastekatsaukset

31.3.2026

Kaisa Raatikainen and Aleksi Raudasoja

Level of evidence: B

Transobturator and retropubic slings are likely as effective in decreasing incontinence symptoms.

A Cochrane review «Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1 compared the effectiveness and safety of retropubic (TVT) versus transobturator (TOT/TVT-O) mid-urethral slings. In short term follow-up (under 1 year), subjective cure rates were similar. In TOT/TVT-O group 83% and in TVT group 84% of patients reported having no urinary incontinence symptoms. The impact was similar but less certain in moderate (1-5 years) and long term (over 5 years) follow ups.

TOT/TVT-O leads more often to reoperation (risk difference 10.2 %, over 5 years follow up) and groin pain (risk difference 4.8 %). Other complications were higher for TVT: major hematoma or visceral injury (risk difference 1.7 %), voiding dysfunction (risk difference 3.3 %), suprapubic pain (risk difference 1.2 %), and bladder or urethral perforation (risk difference 4.8 %).

The evidence certainty was downgraded due to risk of bias and imprecision.

Table 1. Description of the included studies.
Reference	Study type	Population	Intervention and comparison	Outcomes	Risk of bias
RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	SR/MA	Women with stress or mixed urinary incontinence	Retropubic vs transobturator sling	Subjective cure, complications	Moderate

Table 2. Additional comments for included studies.
Reference	Comments
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Risk of bias moderate, mainly due to unclear blinding procedures for patients and outcome assessors.

Results

Table 3. Outcome 1: Subjective cure – short follow up (up to one year).
Reference	Number of studies and number of patients (I/C)	Follow-up time	Absolute number of events (%) RPR	Absolute number of events (%) TOR	Relative effect (95% CI)
Level of evidence: moderate The quality of evidence in is downgraded due to study limitations (mostly due to unclear reporting of random sequence generation and allocation concealment) I=intervention; C=comparison; CI=confidence interval; PGI-1
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	36 trials, 2640/2693	One year	2219 (84 %)	2202 (81.8 %)	0.98 (0.96-1.00)

Table 4. Outcome 2: Subjective cure - medium term follow up (1-5 years).
Reference	Number of studies and number of patients (I/C)	Follow-up time	Absolute number of events (%) RPR	Absolute number of events (%) TOR	Relative effect (95% CI)
Level of evidence: moderate The quality of evidence in is downgraded one level due to imprecision and inconsistency. I=intervention; C=comparison; CI=confidence interval; PGI-1
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	5 trials (344/339)	1-5 years	303 (88.1 %)	291 (84.6 %)	0.97 (0.87-1.09)

Table 5. Outcome 3: Subjective cure long follow up (over 5 years).
Reference	Number of studies and number of patients (I/C)	Follow-up time	Absolute number of events (%) RPR	Absolute number of events (%) TOR	Relative effect (95% CI)
Level of evidence: low The quality of evidence in the long term is downgraded two levels due to inconsistency and imprecision. I=intervention; C=comparison; CI=confidence interval; PGI-1
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	4 trials (341/373)	Over 5 years	241 (70.1 %)	243 (65.1 %)	0.95 (0.80-1.12)

Table 6. Complications.
Reference	Complication	TVT Number of events %	TOT/TVT-O Number of events %	Risk Ratio (95% CI)
Level of evidence: Major hematoma or visceral injury: moderate (study limitations) Voiding dysfunction: moderate (study limitations) De novo urge: moderate (imprecision and study limitations) Vaginal tape erosion: moderate (imprecision and study limitations) Groin pain: moderate (imprecision and study limitations) Suprapubic pain: Moderate (imprecision and study limitations) Bladder/urethral perforation: Moderate (study limitations) Repeat surgery, 1 year: Moderate (imprecision, study limitations) Repeat surgery, 1 to 5 years: Moderate (imprecision, study limitations) Repeat surgery, over 5 years: Moderate (imprecision, study limitations)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Major hematoma or visceral injury	48/2317 2,1 %	10/2359 0,4 %	0.33 (0.19-0.55)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Voiding dysfunction	222/ 3072 7,2%	122/3128 3,9%	0.53 (0.43-0.65)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	De novo urge incontinence	202/2463 8,2 %	209/2460 8,5 %	0.98 (0.82-1.17)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Vaginal tape erosion	47/2298 2,0%	47/2270 2,1%	1.13 (0.78-1.65)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Groin pain	16/1512 1,1%	90/1538 5,9%	4.62 (3.09-6.92)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Suprapubic pain	16/548 2,9%	4/557 0,72%	0.29 (0.11-0.78)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Bladder perforation	154/3069 5,0%	5/3104 0.2%	0.12 (0.08-0.20)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Repeat surgery, 1 year	8/586 1,4%	14/635 2,2%	1.69 (0.75-3.80)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Repeat incontinence surgery 1 to 5 years follow up	1/180 0,6%	32/175 18,3%	21.89 (4.36-109.77)
«Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 »1	Repeat surgery, over 5 years	4/351 1,1%	39/344 11,3%	8.79 (3.36-23.00)

References

Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 2017;7(7):CD006375 «PMID: 28756647»PubMed