目的:系统评价客观和主观的成功,压力性或混合性尿失禁女性患者尿道下悬吊术的手术效果(SUI,MUI)使用合成与具有相应手术入路的非合成材料(耻骨后,RP或经吸波器,TO).
方法:我们系统地搜索了Medline,Embase,EBM评论,使用标准化医学主题词的ClinicalTrials.gov和WebofScienceCoreCollection,没有日期限制(Prospero注册)。我们对研究进行了双重筛选,并使用了反向引文链。
方法:我们包括同行评审的随机对照试验和前瞻性或回顾性比较研究,检查RP或TO合成与非合成(自体,同种异体移植,异种移植物)女性SUI或MUI的吊索,提供英文或法文全文。我们排除了minislings(单个插入点)。我们允许为复发性SUI或MUI使用吊索,和吊索伴随脱垂手术,术后随访至少6周。我们排除了系统评价,荟萃分析,回顾研究,病例对照研究,病例报告,没有描述手术方法或材料的研究,以及组合吊索的研究。
方法:我们使用Cochrane偏差风险工具进行随机对照试验,使用Newcastle-Ottawa量表进行观察性研究,评估研究质量。我们使用合并相对风险(RR)和95%置信区间(CI),通过荟萃分析和荟萃回归评估吊带材料类型对每个结果的影响。
结果:我们筛选了4341篇摘要,评估了104篇全文,保留了35篇手稿(30篇独立研究)。对于RP合成和非合成,客观或主观大陆患者的数量没有差异。与合成相比,非自体RP吊索的SUI和整体再手术率较高。在≥25%复发性SUI的人群中,RP合成和自体吊带与较高的主观失禁相关(RR1.27,95%CI1.12-1.43)。对于TO合成和非合成,尿失禁没有差异。与自体相比,TO合成组的主观满意度更好(RR1.42,95%CI1.03;1.94)。
结论:合成和非合成吊索具有可比的客观和主观成功,手术结果和并发症的差异通常有利于合成材料。
This study aimed to systematically
review objective and subjective success and surgical outcomes of suburethral sling surgery for female patients with stress or mixed urinary incontinence using
synthetic vs nonsynthetic material with corresponding surgical approaches (retropubic or transobturator).
We systematically searched Medline, Embase, EBM Reviews, ClinicalTrials.gov, and Web of Science Core Collection using standardized Medical Subject Headings (MeSH) without date restrictions (PROSPERO-registered). We double-screened studies and used backward citation chaining.
We included peer-reviewed randomized controlled trials and prospective or retrospective comparative studies examining outcomes of retropubic or transobturator synthetic vs nonsynthetic (autologous, allograft, or xenograft) slings for female stress or mixed urinary incontinence, with available English or French full texts. We excluded minislings (single insertion point). We allowed slings for recurrent stress or mixed urinary incontinence, and slings concomitant with prolapse surgery, with at least 6 weeks of postoperative follow-up. We excluded systematic reviews, meta-analyses,
review studies, case-control studies, case reports, studies that did not describe surgical approach or material, and studies of combination slings.
We evaluated study quality using RoB, the Cochrane risk-of-bias tool for randomized controlled trials, and the Newcastle-Ottawa scale for observational studies. We used pooled relative risk with 95% confidence intervals to estimate the effect of sling material type on each outcome through meta-analysis and meta-regression, as appropriate.
We screened 4341 abstracts, assessed 104 full texts, and retained 35 articles (30 separate studies). For retropubic synthetic vs nonsynthetic slings, there was no difference in the number of objectively or subjectively continent patients. The rates of reoperation for stress urinary incontinence and overall were higher with nonautologous retropubic slings than with synthetic slings. Compared with autologous slings, retropubic synthetic slings were associated with higher subjective continence in populations with ≥25% recurrent stress urinary incontinence (relative risk, 1.27; 95% confidence interval, 1.12-1.43). There were no differences in continence between transobturator
synthetic and nonsynthetic slings. Subjective satisfaction was better in the transobturator synthetic group than in the autologous sling group (relative risk, 1.42; 95% confidence interval, 1.03-1.94).
Synthetic and nonsynthetic slings have comparable objective and subjective success, with
synthetic materials generally showing better operative outcomes and fewer complications.