Surgical Treatment of Recurrent Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis of Randomised Controlled Trials

Wael Agur*, Mohamed Riad, Silvia Secco, Heather Litman, Priya Madhuvrata, Giacomo Novara, Mohamed Abdel-Fattah

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


Context                                                                                                   Recurrent stress urinary incontinence (R-SUI) represents a management dilemma; however, only a limited number of randomised controlled trials (RCTs) have assessed the various surgical procedures used for its treatment. 

Objective                                                                                                               To assess the effectiveness and complications of various surgical procedures for the treatment of female R-SUI.

Evidence acquisition                                                                                            A prospective peer-reviewed protocol was prepared a priori. A systematic literature review of all published RCTs comparing surgical procedures for treatment of R-SUI was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Data were analysed using RevMan 5. 

Evidence synthesis                                                                                            We conducted a literature search from 1945 to February 2013. Data were available for a total of 350 women in 10 RCTs with a mean follow-up of 18.1 mo. Meta-analysis was possible for the comparison of retropubic tension-free vaginal tape (RP-TVT) versus transobturator tension-free vaginal tape (TO-TVT) in five RCTs (n = 135). There was no statistically significant difference between RP-TVT and TO-TVT in the patient-reported improvement (odds ratio [OR]: 0.84, 95% confidence interval [CI], 0.41-1.69) or objective cure/improvement (OR: 1.75; 95% CI, 0.86-3.54). One RCT showed a trend towards a higher rate of patient-reported and objective cure/improvement with the inside-out TO-TVT compared with the outside-in; however, it was not statistically significant (OR: 3.00; 95% CI, 0.85-10.57, and OR: 3.32; 95% CI, 0.96-11.41, respectively). There was no significant difference between Burch colposuspension and RP-TVT (one RCT) in patient-reported improvement (OR: 0.33; 95% CI, 0.01-8.57) or objective cure/improvement (OR: 0.52; 95% CI, 0.13-2.05). 

Conclusions                                                                                                       This meta-analysis shows no evidence of a significant difference in patient-reported and objective cure/improvement rates between RP-TVT and TO-TVT in the surgical treatment of women with R-SUI. However, due to the relatively low number of patients, the analysis might be underpowered. This review highlights the poor level of evidence in this field and the need for well-designed clinical trials to address this important clinical dilemma.

Original languageEnglish
Pages (from-to)323-336
Number of pages14
JournalEuropean Urology
Issue number2
Early online date26 Apr 2013
Publication statusPublished - Aug 2013

Bibliographical note

We would like to thank all the authors who responded to us and those who provided their study data. Special thanks goes to Dr Karen Bell, Head of Research and Development, Julie Wands, Library Manager, NHS Ayrshire and Arran, and Ms Genevieve Cseh, Research PA, University of Aberdeen, for logistic and administrative support.


  • Colposuspension
  • Complications
  • Recurrent urinary incontinence
  • Suburethral slings
  • Tension-free vaginal tape
  • Transobturator tape
  • Urodynamic stress incontinence


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