Success rates are similar between synthetic and nonsynthetic slings for stress urinary incontinence (SUI) in women, according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- Synthetic and nonsynthetic slings show similar success rates in treating stress urinary incontinence (SUI) in women
- Synthetic slings are associated with better operative outcomes, including shorter operative time, reduced blood loss, and shorter hospital stays.
- Patients with synthetic slings experience fewer complications, such as lower rates of urinary retention and pain, compared to those with nonsynthetic slings.
- While synthetic slings have many benefits, they come with a higher risk of bladder injury compared to nonsynthetic slings.
- Both types of slings provide similar outcomes in terms of achieving continence, though synthetic slings show some advantage in cases with high recurrence rates of SUI.
Midurethral slings (MUS) are the most thoroughly evaluated treatment for SUI, which impacts approximately half of aging women. However, restrictions have been placed on mesh following warnings from the FDA, significantly reducing the prevalence of synthetic mesh MUS procedures.
Comparative evidence is necessary to allow informed decision-making surrounding treatment among patients. This evidence should compare retropubic (RP) and transobturator (TO) routes of insertion and be used for female patient counseling toward surgical options for urinary incontinence (UI).
Investigators conducted a study to determine the objective and subjective success, surgical outcomes, and complications of suburethral sling surgery for SUI or mixed UI (MUI) among female patients. Women aged over 18 years with primary or recurrent UI requiring surgical intervention were included in the analysis.
Participants were diagnosed with urodynamic SUI, SUI, or MUI. The study included peer-reviewed randomized controlled trials and prospective or retrospective comparative studies comparing outcome of synthetic vs nonsynthetic slings for female stress or MUI surgery. Literature was written in English or French and available as full text.
Synthetic suburethral sling procedures used either an RP or TO approach, with at least 6 weeks of postoperative follow-up. Articles were found through searches of the Embase, Medline, EBM Reviews, Web of Science Core Collection, and ClinicalTrials.gov databases.
Studies were selected through double screening, with relevant information including year of publication, authors, study design, type and route of sling, populations demographics, and postoperative follow-up time. Objective and subjective postoperative SUI or MUI cure or improvement were extracted as the primary outcomes of the analysis.
Secondary outcomes included urgency UI cure or improvement, surgical outcomes of operative time, blood loss, length of hospital stay, and time of catheterization. Two reviewers performed reverification of extracted data, with disagreements resolved by a third reviewer. Short-term, medium-term, long-term, and very long-term outcomes were reported.
Objective cure was assessed using 15 studies of outcomes after RP sling procedure, including 1427 synthetic sling patients vs 1039 nonsynthetic sling patients. Patients were aged a mean 52.6 years, and the median follow-up period was 1.8 years.
Subjective cure was assessed using 13 studies with 1580 synthetic patients and 1152 nonsynthetic patients receiving RP sling procedure. Patients were aged a mean 55.5 years, and the median follow-up period was 2.4 years.
Operative time, length of hospital stay, duration of bladder catheterization, blood loss, and urinary retention complication outcomes were significantly improved from RP-MUS vs autologous slings. However, operating room time, length of hospital stay, and urinary retention did not differ between RP synthetic and nonautologous slings.
The rate of persistent or de novo urge UI was also significantly increased after synthetic vs autologous fascial sling with a risk ratio (RR) of 1.96. However, postoperative antispasmodic medication use was reduced, with an RR of 0.16.
Reoperation for recurrent SUI, total reoperation, and UTI rates were all reduced from synthetic slings, with RRs of 0.22, 0.02, and 0.50, respectively, compared to nonautologous RP slings. Additionally, RP synthetic slings were favorable for urinary retention and pain vs autologous slings, with RRs of 0.55 and 0.38, respectively.
Improvements in outcomes for RP synthetic slings remained for operating room time and length of hospital delivery. However, these patients more often had bladder injury, with an RR of 2.72.
Similar outcomes were reported between groups for objective continence. Subjective continence was also similar between groups, but studies with a recurrent SUI rate of 25% or more found improved subjective continence from synthetic vs autologous slings, with an RR of 1.27.
These results indicated comparable success between synthetic and nonsynthetic slings, with operative outcomes improved and complications reduced from synthetic slings. Investigators concluded this data, “offers important directions for future research in this area of women’s health.”
Reference
Larouche M, Mu Zi Zheng M, Yang EC, et al. Synthetic vs nonsynthetic slings for female stress and mixed urinary incontinence: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology. 2024;231(2):166-186.E8. doi:10.1016/j.ajog.2024.02.306
