Clinical outcome of single‐incision slings, excluding TVT‐Secur, vs standard slings in the surgical management of stress incontinence: an updated systematic review and meta‐analysis

The aim of the present paper was to assess and compare the long‐term efficacy and safety of single‐incision mini‐slings (SIMSs), except tension‐free vaginal tape (TVT)‐Secur, with standard midurethral slings (SMUSs) for female stress urinary incontinence through an updated systematic review and meta‐analysis of randomized controlled trials (RCTs) comparing these two surgical methods. A literature review of all RCTs comparing SIMSs (Mini‐Arc, Contasure‐Needleless, Ophira, Tissue Fixation System and Ajust), except TVT‐Secur, with SMUSs was performed. The Medline, Embase, Scopus, Web of Science and Cochrane Controlled Trial Register databases were reviewed. We retrieved 29 RCTs (including a total of 2 986 patients) that compared SIMSs, except TVT‐Secur, with SMUSs. Meta‐analysis of long‐term results showed no significant difference in the patient‐reported cure rate (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.44–1.60); however, we found that SMUSs had a significantly superior objective cure rate (OR 0.68, 95% CI 0.47–0.99; P = 0.04). SIMSs were associated with a significantly shorter operation time, lower immediate postoperative pain based on a visual analogue scale score, lower intra‐operative blood loss, and lower postoperative voiding dysfunction. The meta‐analysis showed clear evidence of the superiority of SMUSs over SIMSs, except TVT‐Secur, in terms of the objective cure rate, after long‐term follow‐up; however, SIMSs were superior with respect to immediate postoperative pain, intra‐operative blood loss, and postoperative voiding dysfunction.