The Efficacy and Safety of Single-Incision Mini-Slings for Stress Urinary Incontinence: A Network Meta-Analysis
Vol. 20 (2023),
Purpose: To evaluate the efficacy and safety of single-incision mini-sling for stress urinary incontinence based on network Meta-analysis.
Materials and Methods: We searched PubMed, Embase, and Cochrane libraries from August 2008 to August 2019. Randomized controlled trials comparing two or more indicators of Miniarc (Single Incision Mini-slings), Ajust (Adjustable Single-Incision Sling), C-NDL (Contasure-Needleless), TFS (Tissue Fixation System), Ophria (Transobturator Vaginal Tap), TVT-O (Transobturator Vaginal Tape), and TOT (Trans-obturatortape) in treating female stress urinary incontinence were collected.
Results: Totally, 3,428 patients from 21 studies were included. Ajust had the highest subjective cure rate (Rank=0.52), while Ophira had the worst (Rank=0.67). TFS had the highest objective cure rate, and the worst was found in Ophira. TFS required the shortest operating time (Rank=0.40), while TVT-O required the longest operating time (Rank=0.47). Miniarc had the least bleeding (Rank=0.47), while TVT-O had the most bleeding (Rank=0.37). C-NDL had the shortest postoperative hospital stay (Rank=0.77), while Ajust had the longest postoperative hospital stay (Rank=0.36). For postoperative complications, TFS performed best in groin pain (Rank=0.84), urinary retention (Rank=0.78), and repeat surgery (Rank=0.45). TVT-O performed worst in groin pain (Rank=0.36), and urinary retention (Rank=0.58). Miniarc had the highest repeat surgery rate (Rank=0.35). Ajust had the lowest probability of tap erosion (Rank=0.30), while Ophira had the highest tap erosion level (Rank=0.45). Miniarc showed the greatest advantage in urinary tract infections (Rank=0.84) and de novo urgency (Rank=0.60), while C-NDL had the highest incidence of urethral infections (Rank=0.51). Ophira performed worst in de novo urgency (Rank=0.60). C-NDL performed the best in sexual intercourse pain (Rank=0.79) while Ajust was the worst (Rank=0.49).
Conclusions: In view of comprehensive efficacy and safety, we recommend that TFS or Ajust should be selected first for single-incision sling and the application of Ophria should be minimized.
- Single Incision Mini-slings
- Transobturator Tension-free Vaginal Tapes
- Network Meta-Analysis
- Stress Urinary Incontinence
How to Cite
Hogewoning CR, Ruhe IM, Bekker MD, et al. The MiniArc sling for female stress urinary incontinence: clinical results after 1-year follow-up. Int Urogynecol J. 2012;23:589-595.
Aponte MM, Shah SR, Hickling D, Brucker BM, Rosenblum N, Nitti VW. Urodynamics for clinically suspected obstruction after anti-incontinence surgery in women. J Urol. 2013;190:598-602.
Friedman B. Conservative treatment for female stress urinary incontinence: simple, reasonable and safe. Can Urol Assoc J. 2012;6:61-63.
Rautenberg O, Zivanovic I, Kociszewski J, et al. Current Treatment Concepts for Stress Urinary Incontinence. Praxis (Bern 1994). 2017;106:829e-836e.
Lapitan MCM, Cody JD, Mashayekhi A. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database Syst Rev. 2017;7:CD002912.
McGuire EJ, Bennett CJ, Konnak JA, Sonda LP, Savastano JA. Experience with pubovaginal slings for urinary incontinence at the University of Michigan. J Urol. 1987;138:525-526.
Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7:81-85; discussion 85-86.
Frydman V, Cornu J. Have mini-slings come of age? Curr Opin Urol. 2015;25:296-299.
Melendez-Munoz J, Braverman M, Rosamilia A, Young N, Leitch A, Lee JK. TVT Abbrevo and Miniarc suburethral sling in women with stress urinary incontinence - A randomised controlled trial. Eur J Obstet Gynecol Reprod Biol. 2018;230:141-146.
Pascom ALG, Djehdian LM, Bortolini MAT, et al. Randomized controlled trial comparing single-incision mini-sling and transobturator midurethral sling for the treatment of stress urinary incontinence: 3-year follow-up results. Neurourol Urodyn. 2018;37:2184-2190.
Schellart RP, Zwolsman SE, Lucot JP, de Ridder D, Dijkgraaf MGW, Roovers JWR. A randomized, nonblinded extension study of single-incision versus transobturator midurethral sling in women with stress urinary incontinence. Int Urogynecol J. 2018;29:37-44.
Fernandez-Gonzalez S, Martinez Franco E, Lin Miao X, Amat Tardiu L. Contasure-needleless(R) compared with Monarc(R) for the treatment of stress urinary incontinence. Int Urogynecol J. 2017;28:1077-1084.
Gaber ME, Borg T, Samour H, Nawara M, Reda A. Two new mini-slings compared with transobturator tension-free vaginal tape for treatment of stress urinary incontinence: A 1-year follow-up randomized controlled trial. J Obstet Gynaecol Res. 2016;42:1773-1781.
Masata J, Svabik K, Zvara K, Hubka P, Toman A, Martan A. Comparison of the efficacy of tension-free vaginal tape obturator (TVT-O) and single-incision tension-free vaginal tape (Ajust) in the treatment of female stress urinary incontinence: a 1-year follow-up randomized trial. Int Urogynecol J. 2016;27:1497-1505.
Dogan O, Kaya AE, Pulatoglu C, Basbug A, Yassa M. A randomized comparison of a single-incision needleless (Contasure-needleless(R)) mini-sling versus an inside-out transobturator (Contasure-KIM(R)) mid-urethral sling in women with stress urinary incontinence: 24-month follow-up results. Int Urogynecol J. 2018;29:1387-1395.
Xin X, Song Y, Xia Z. A comparison between adjustable single-incision sling and tension-free vaginal tape-obturator in treating stress urinary incontinence. Arch Gynecol Obstet. 2016;293:457-463.
Liapis A, Bakas P, Creatsas G. Monarc vs TVT-O for the treatment of primary stress incontinence: a randomized study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:185-190.
Sivaslioglu AA, Unlubilgin E, Aydogmus S, Keskin L, Dolen I. A prospective randomized controlled trial of the transobturator tape and tissue fixation mini-sling in patients with stress urinary incontinence: 5-year results. J Urol. 2012;188:194-199.
Tieu AL, Hegde A, Castillo PA, Davila GW, Aguilar VC. Transobturator versus single incision slings: 1-year results of a randomized controlled trial. Int Urogynecol J. 2017;28:461-467.
Mostafa A, Agur W, Abdel-All M, et al. Multicenter prospective randomized study of single-incision mini-sling vs tension-free vaginal tape-obturator in management of female stress urinary incontinence: a minimum of 1-year follow-up. Urology. 2013;82:552-559.
Grigoriadis C, Bakas P, Derpapas A, Creatsa M, Liapis A. Tension-free vaginal tape obturator versus Ajust adjustable single incision sling procedure in women with urodynamic stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2013;170:563-566.
Scheiner DA, Betschart C, Wiederkehr S, Seifert B, Fink D, Perucchini D. Twelve months effect on voiding function of retropubic compared with outside-in and inside-out transobturator midurethral slings. Int Urogynecol J. 2012;23:197-206.
Boyers D, Kilonzo M, Mostafa A, Abdel-Fattah M. Comparison of an adjustable anchored single-incision mini-sling, Ajust((R)) , with a standard mid-urethral sling, TVT-O(TM) : a health economic evaluation. BJU Int. 2013;112:1169-1177.
Martinez Franco E, Amat Tardiu L. Contasure-Needleless(R) single incision sling compared with transobturator TVT-O(R) for the treatment of stress urinary incontinence: long-term results. Int Urogynecol J. 2015;26:213-218.
Sabadell J, Palau-Gené M, Huguet E, Montero-Armengol A, Salicrú S, Poza JL. Multicentre randomized trial of the Ajust™ single-incision sling compared to the Align™ transobturator tape sling. Int Urogynecol J. 2017;28:1041-1047.
Jurakova M, Huser M, Belkov I, et al. Prospective randomized comparison of the transobturator mid-urethral sling with the single-incision sling among women with stress urinary incontinence: 1-year follow-up study. Int Urogynecol J. 2016;27:791-796.
Abdel-Fattah M, Mostafa A, Familusi A, Ramsay I, N'Dow J. Prospective randomised controlled trial of transobturator tapes in management of urodynamic stress incontinence in women: 3-year outcomes from the Evaluation of Transobturator Tapes study. Eur Urol. 2012;62:843-851.
Fu Q, Lv J, Fang W, et al. The clinical efficacy of needleless sling technique and TOT in the treatment of female stress urinary incontinence a prospective randomized controlled trial. Int J Clin Exp Med. 2017;10:7084-7089.
Schweitzer KJ, Milani AL, van Eijndhoven HWF, et al. Postoperative pain after adjustable single-incision or transobturator sling for incontinence: a randomized controlled trial. Obstet Gynecol. 2015;125:27-34.
Yao D, Wei J, Zhang X, et al. Transobturator surgery for female stress incontinence: a comparative anatomical study of outside-in VS inside-out techniques. J Clin Urol. 2008:728-730.
Achtari C, McKenzie BJ, Hiscock R, et al. Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:330-334.
Naumann G, Albrich S, Skala C, Laterza R, Kolbl H. Single-Incision Slings (SIS) - a New Option for the Surgical Treatment of Female Stress Urinary Incontinence. Geburtshilfe Frauenheilkd. 2012;72:125-131.
Mostafa A, Lim CP, Hopper L, Madhuvrata P, Abdel-Fattah M. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: an updated systematic review and meta-analysis of effectiveness and complications. Eur Urol. 2014;65:402-427.
Abdel-Fattah M, Ford JA, Lim CP, Madhuvrata P. Single-incision mini-slings versus standard midurethral slings in surgical management of female stress urinary incontinence: a meta-analysis of effectiveness and complications. Eur Urol. 2011;60:468-480.
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