Effectiveness And Safety Assessment Of TVT,TOT And Burch For The Treatment Of Female Stress Urinary Incontinence:Meta-analysis

Objective:To evaluate effectiveness and safety of tension-free vaginal tape(TVT) compared with Burch colposuspension and with trans-obturator tape (TOT, outside-in) for the treatment of Female Stress Urinary Incontinence.Methods:The open published randomized controlled trials(RCT) of both Chinese and English about TVT vesus Burch colposuspension and TVT vesus TOT in the treatment of Female Stress Urinary Incontinence all over the world were searched by Pubmed,EMBASE,CNKI,Sciencedirect between in January1996and in January2012,as well as manual search for the reference of the selected RCT. Two reviewers screened the literature,evaluated the quality and extracted the relevant data independently,with confirmation by crosscheck.Various opinion were dealt by discussion or consulted by the expert.The methodological quality of selected literature was used by Jadad score to evaluate.Meta-analysis was conducted using the Review Manager software5.1supplied by Cochrane Collaboration.Results:Our search identified13randomized controlled trials Comparing TVT with Burch colposuspension, Including887patients, Meta-analysis showed that the mean operative time and the mean postoperative days in hospital after TVT are less than Burch colposuspension,the overall cure rate after TVT were1.33,2.31times higher than open Burch colposuspension,laparoscopic Burch colposuspension respectively.The objective cure measured by negative stress test after TVT were2.08,3.64times higher than open Burch colposuspension,laparoscopic Burch colposuspension respectively. The objective cure measured by negative pad test after TVT was1.42times higher than open Burch colposuspension,but there is no significant difference comparing with laparoscopic Burch colposuspension.The rate of postoperation bladder or vaginal perforations was6.33times higher than open Burch colposuspension,and no significant difference comparing with laparoscopic Burch colposuspension.The re-operation rate was lower57%than open Burch colposuspension,and no significant difference comparing with laparoscopic Burch colposuspension.There were similar after TVT and Burch colposuspension in refer to postoperation haematoma,urinary tract infection,storage LUTS,voiding LUTS,vaginal erosion,wound infection(P>0.1). Our search identified7randomized controlled trials Comparing TVT with TOT, Including1012patients, Meta-analysis showed that there were similar in the operative time,overall cure rate,objective cure rate measured by negative stress test or negative pad test, bladder or vaginal perforations, postoperation haematoma,urinary tract infection,storage LUTS,voiding LUTS,vaginal erosion, total complication rate of perioperative respectively(P>0.1).However,the rate of groin pain after TVT was lower73%than TOT.Conclusion:TVT,TOT and Burch colposuspension were the effective operation method for the treatment of Female Stress Urinary Incontinence.TVT was associated with superior success cure,lower risk of reoperation and higher risk of bladder or vaginal perforations compared with Burch colposuspension.There were similar in success cure and complication between TVT and TOT,excepted for higher risk of groin pain after TOT.Certainly, Continuous updated RCT are needed to validate effectiveness and safety...