| Objective:To compare the effectiveness and complications between the retropubic and transobturator approaches for the treatment of female SUI.Methods:We analyzed the clinical information of152women (80in TOT and72in SPARC) in our hospital from July2007to September2011. These women were confirmed SUI by symptom of incontinence when abdominal pressure suddenly up. We collected the clinical characters and perioperative complications of all the patients. All the patients were asked to complete some validated questionnaires such as ICI-Q-SF, PISQ-12and UDI-6/ⅡQ-7. We collected the Qmax and PVR before and after operation to study whether SPARC or TOT tape lead to BOO.We made the include and exclude criteria and searche strategy. We selected all randomized researches that compared retropubic and transobturator midurethal slings for treatment of SUI. We used fixed effects models to estimate pooled odds ratios and95%confidence intervals for objective and subjective cure rate, complications, de novo urgency symptoms and voiding dysfunction after operationResults:The results of patients in our hospital:①There was a significant difference between the operating time in the two methods (P<0.05).②There were significant improvements of average symptom and QOL scores in the ICI-Q-SF questionnaire and UDI-6/ⅡQ-7questionnaires in both SPARC group and TOT group (P=0.00). There were no significant improvement of the PISQ-12scores in the two groups (P>0.05).③There were no significient differences between the cure/improve rates of the two methods (P>0.05).④There were20patients diagnosed as serious SUI in the SPARC group and3cases(15.0%) got no improvements after operation; there were22patients diagnosed as serious SUI in the TOT group and10cases(45.5%) confirmed as fail after operation.⑤The perioperative complications in SPARC and TOT groups were low.⑥The postoperative Qmax were significantly lower than preoperative Qmax in both the two groups (P=0.00).But there were no significant different between the preoperative PVR and postoperative PVR in the two groups (P>0.05).In the systematic review and meta-analysis:Sixteen randomized studies compared retropubic and transobturator approaches to midurethral slings were included. There were ten RCTs that compared TVT with TVT-Oand five RCTs that compared TVT with TOT. In the subgroup analysis which was made on the basis of different anti-incontinence approaches ("TVT-O vs TVT" and "TOT vs TVT"), there were no differents in objective cure rates:[OR0.86,95%CI(0.63-1.86)]. And the evidence to support if one approach leads to better objective cure rate was also insufficient total [OR1.02,95%CI(0.77-1.34)]. The transobturator approach was associated with less risks of bladder perforation,retropubic/vaginal hematoma,long-term voiding dysfunction:[OR0.17,95%CI(0.09-0.32)],[OR0.32,95%CI(0.16-0.63)],[OR0.32,95%CI(0.170.61)].But the transobturator approach appear to associated with higher risk of thigh/groin pain [OR2.53,95%CI(1.72-3.72)].We found no statistic differences in transient voiding dysfunction, de nove urgency and tape erosion between the two approaches.Conclusion:Our research shows analogical objective and subjective cure rates between retropubic and transobturator midurethral slings.The transobturator approach is associated with a lower risk of several complications. However, the risk of thigh/groin pain between the two approaches is not clear. The SPARC procedure is associated with higher cure rate in patients diagnosed as serious SUI in comparision with TOT procedure. The surgeons should chose a proper approach between retropubic and transobturator tape in considering of the patients characters. |
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