American journal of obstetrics and gynecology · 2026
Bladder Neck Versus Midurethral Placement of Retropubic Autologous Fascial Slings: A Systematic Review.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
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Konci Rea, Reuveni-Salzman Adi, Sirmakesyan Stephanie, Bentaleb Jouhayna, Singh Simranjit, Belzile Eric, Gill Prubjot Kaur, Geoffrion Roxana, Larouche Maryse
Аннотация
OBJECTIVE: This study aimed to compare objective and subjective cure/improvement rates and surgical outcomes of female patients with stress or mixed urinary incontinence undergoing autologous retropubic pubovaginal slings between traditional bladder neck sling placement and midurethral sling placement.
DATA SOURCES: A systematic search of Medline, Embase, CENTRAL, and ClinicalTrials.gov was conducted using standardized MeSH terms from conception to March 2025 (PROSPERO-registered). Studies underwent double screening, and a third reviewer resolved any discrepancies.
STUDY ELIGIBILITY CRITERIA: We included peer-reviewed randomized controlled trials (RCTs) and observational studies evaluating outcomes of retropubic autologous slings for stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). Studies published in English or French were eligible for inclusion. We included slings performed for recurrent SUI or MUI, as well as those placed concomitantly with prolapse surgery, providing a minimum postoperative follow-up of six weeks was reported. We excluded systematic reviews, meta-analyses, review articles, case reports, studies lacking details on surgical approach or sling material, and studies evaluating non-autologous slings.
STUDY APPRAISAL AND SYNTHESIS METHODS: We evaluated study quality using RoB, the Cochrane risk-of-bias tool for randomized controlled trials, and the National Heart Lung and Blood Institute (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We present odds ratios with 95% confidence intervals to estimate the effect of sling placement location on each outcome through random-effect logistic regression.
RESULTS: We screened 5578 abstracts, assessed 233 full texts for eligibility, and retained 61 studies. 13 of these were randomized controlled trials and 48 were observational studies. Objective (74.0% vs. 81.1%, OR 1.10 [0.37-3.28]) and subjective cure (70.8% vs. 58.6 %, OR 0.46 [0.19-1.10]) were not statistically significantly different between bladder neck vs. midurethral placement of retropubic autologous fascial sling at a median of 2.4 years [0.3-6.8] postoperatively. Objective improvement (90.5% vs.84.5%, OR 0.41 [0.10-1.67]) and subjective improvement (85.9% vs. 85.1%, OR 0.77 [0.31-1.92]) rates were also similar between the groups. Most adverse events were similar between groups except midurethral placement was associated with a lower risk of de novo urgency (15.0% vs 8.3%, OR 0.50 [0.26-0.96]). Study quality assessment using the RoB tool for RCT and the NIH Quality Assessment of Observational Control and Cross-Sectional studies overall revealed a moderate to high risk of bias among included studies.
CONCLUSION: Bladder neck and midurethral placements of autologous slings have similar surgical success and adverse effects rates, with the exception of de novo urgency which favours midurethral sling placement. A randomized controlled trial is required to confirm these findings.
DATA SOURCES: A systematic search of Medline, Embase, CENTRAL, and ClinicalTrials.gov was conducted using standardized MeSH terms from conception to March 2025 (PROSPERO-registered). Studies underwent double screening, and a third reviewer resolved any discrepancies.
STUDY ELIGIBILITY CRITERIA: We included peer-reviewed randomized controlled trials (RCTs) and observational studies evaluating outcomes of retropubic autologous slings for stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). Studies published in English or French were eligible for inclusion. We included slings performed for recurrent SUI or MUI, as well as those placed concomitantly with prolapse surgery, providing a minimum postoperative follow-up of six weeks was reported. We excluded systematic reviews, meta-analyses, review articles, case reports, studies lacking details on surgical approach or sling material, and studies evaluating non-autologous slings.
STUDY APPRAISAL AND SYNTHESIS METHODS: We evaluated study quality using RoB, the Cochrane risk-of-bias tool for randomized controlled trials, and the National Heart Lung and Blood Institute (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. We present odds ratios with 95% confidence intervals to estimate the effect of sling placement location on each outcome through random-effect logistic regression.
RESULTS: We screened 5578 abstracts, assessed 233 full texts for eligibility, and retained 61 studies. 13 of these were randomized controlled trials and 48 were observational studies. Objective (74.0% vs. 81.1%, OR 1.10 [0.37-3.28]) and subjective cure (70.8% vs. 58.6 %, OR 0.46 [0.19-1.10]) were not statistically significantly different between bladder neck vs. midurethral placement of retropubic autologous fascial sling at a median of 2.4 years [0.3-6.8] postoperatively. Objective improvement (90.5% vs.84.5%, OR 0.41 [0.10-1.67]) and subjective improvement (85.9% vs. 85.1%, OR 0.77 [0.31-1.92]) rates were also similar between the groups. Most adverse events were similar between groups except midurethral placement was associated with a lower risk of de novo urgency (15.0% vs 8.3%, OR 0.50 [0.26-0.96]). Study quality assessment using the RoB tool for RCT and the NIH Quality Assessment of Observational Control and Cross-Sectional studies overall revealed a moderate to high risk of bias among included studies.
CONCLUSION: Bladder neck and midurethral placements of autologous slings have similar surgical success and adverse effects rates, with the exception of de novo urgency which favours midurethral sling placement. A randomized controlled trial is required to confirm these findings.