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Bladder neck needle suspension for urinary incontinence in women

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References

References to studies included in this review

Athanassopoulos 1996 {published data only}

Athanassopoulos A, Barbalias G. Burch colposuspension versus Stamey endoscopic bladder neck suspension: a urodynamic appraisal. Urologia Internationalis 1996;56(1):23‐7.
Athanassopoulos A, Liatsikos EN, Perimenis P, Barbalias GA. Female stress urinary incontinence: predictive factors for the operative correction (Abstract). International Urogynecology Journal and Pelvic Floor Dysfunction 1999;10(Suppl 1):S140.

Bergman 1989a {published data only}

Bergman A, Ballard CA, Koonings PP. Comparison of three different surgical procedures for genuine stress incontinence: prospective randomized study. American Journal of Obstetrics & Gynecology 1989;160(5 Pt 1):1102‐6.
Bergman A, Elia G. Three surgical procedures for genuine stress incontinence: five‐year follow‐up of a prospective randomized study. American Journal of Obstetrics & Gynecology 1995;173(1):66‐71.
Elia G, Bergman A. Prospective randomized comparison of three surgical procedures for stress urinary incontinence: five year follow‐up (Abstract). Neurourology & Urodynamics 1994;13(4):498‐500.
Elia G, Bergman J, Klutke JJ, Klutke CG. Urethral resistance after surgery for stress urinary incontinence: do we obstruct to have a successful outcome?. Urodinamica 2000;10(1):32‐7.

Bergman 1989b {published data only}

Bergman A, Ballard CA, Koonings PP. Primary stress urinary incontinence and pelvic relaxation: prospective randomised comparison of 3 different operations (Abstract). Neurourology and Urodynamics 1989;8(4):334‐5.
Bergman A, Koonings PP, Ballard CA. Primary stress urinary incontinence and pelvic relaxation: prospective randomized comparison of three different operations. American Journal of Obstetrics & Gynecology 1989;161(1):97‐101.
Klutke JJ, Klutke CG, Bergman J, Elia G. Urodynamics changes in voiding after anti‐incontinence surgery: an insight into the mechanism of cure. Urology 1999;54(6):1003‐7.

Di Palumbo 2003 {published data only}

Di Palumbo VS. Four‐corner bladder and urethral retropubic suspension versus anterior colporrhaphy in the correction of stress urinary incontinence with urethrocystocele 3‐4. Randomized clinical trial. Urogynaecologia International Journal 2003;17(2):57‐68.

German 1992 {published data only}

German K, Goodman C, Haynes R, Stephenson TP. A randomised trial comparing a modified needle suspension procedure with the vagina/obturator shelf procedure for genuine stress incontinence. Proceedings of the 22nd Annual Meeting of the International Continence Society; Sept 1‐4; Halifax, UK. Bristol: International Continence Society, 1992.
German KA, Kynaston H, Weight S, Stephenson TP. A prospective randomized trial comparing a modified needle suspension procedure with the vagina/obturator shelf procedure for genuine stress incontinence. British Journal of Urology 1994;74(2):188‐90.

Gilja 1998 {published data only}

Gilja I, Puskar D, Mazuran B, Radej M. Comparative analysis of bladder neck suspension using Raz, Burch and transvaginal Burch procedures. A 3‐year randomized prospective study. European Urology 1998;33:298‐302.

Hilton 1989 {published data only}

Hilton P. A clinical and urodynamic study comparing the Stamey bladder neck suspension and suburethral sling procedures in the treatment of genuine stress incontinence. British Journal of Obstetrics & Gynaecology 1989;96(2):213‐20.

Mundy 1983 {published data only}

Mundy AR. A trial comparing the Stamey bladder neck suspension procedure with colposuspension for the treatment of stress incontinence. British Journal of Urology 1983;55(6):687‐90.
Mundy AR. The role of the Stamey bladder neck suspension procedure in the treatment of stress incontinence of urine. Proceedings of the International Continence Society (ICS); 1982; Leiden, Germany.1982:137.

Palma 1985 {published and unpublished data}

Palma P, David S, Pinotti JA. Comparative study between the Marshall‐Marchetti‐Krantz operation and the endoscopic suspension of the bladder neck for surgical correction of stress urinary incontinence (Abstract). Archives of Gynecology 1985;237 (Suppl):402.
Palma PC, Soffiatti SA, Almeida SC, Pinotti JA. Stress urinary incontinence: a comparative study of surgical treatment by the Marshall‐Marchetti‐Krantz technique with endoscopic suspension of the bladder neck. Second report. Asia Oceania Journal of Obstetrics & Gynaecology 1988;14(1):31‐6.
Palma PCR, Suely A, Soffiatti D, Pinotti JA. Stress urinary incontinence: a comparative study of the surgical treatment by the Marshall‐Marchetti‐Krantz technique with endoscopic suspension of the bladder neck. Second report. Ginecologia and Obstetricia (Sociedad Peruana de Obstetricia y Ginecologia) 1986;30(2):15‐9.

Stein 1991 {published data only}

Stein M, Weinberg JJ. Polytetrafluoroethylene versus polypropylene suture for endoscopic bladder neck suspension. Urology 1991;38(2):119‐22.

References to studies excluded from this review

Bump 1995 {published data only}

Bump RC, Hurt WG, Elser DM, Theofrastous JP, Fantl JA, McClish DK. Reliability of intra‐operative anatomic, endoscopic and urodynamic measurements and their correlation with post‐operative pressure transmission in women undergoing bladder neck suspension surgery (Abstract). Neurourology & Urodynamics 1995;14(5):490‐1.

Bump 1996 {published data only}

Bump RC, Hurt WG, Theofrastous JP, Addison WA, Fantl JA, Wyman JF, et al. Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse. The Continence Program for Women Research Group. American Journal of Obstetrics & Gynecology 1996;175(2):326‐35.

Colombo 1997 {published data only}

Colombo M, Maggioni A, Scalambrino S, Vitobello D, Milani R. Surgery for genitourinary prolapse and stress incontinence: a randomized trial of posterior pubourethral ligament plication and Pereyra suspension. American Journal of Obstetrics & Gynecology 1997;176(2):337‐43.
Colombo M, Milani R, Vitobello D, Maggioni A. A randomized comparison of Burch colposuspension and abdominal paravaginal defect repair for female stress urinary incontinence. American Journal of Obstetrics & Gynecology 1996;175(1):78‐84.
Milani R, Vitobello D, Teruzzi M, Colombo M. Comparison of Burch colposuspension and paravaginal defects repair for patients with genuine stress urinary incontinence (Abstract). Proceedings of the International Continence Society (ICS), 25th Annual Meeting; 1995 Oct 17‐20; Sydney, Australia. 1995:475.

Corcos 2001 {published data only}

Corcos J, Collet JP, Shapiro S, Herschorn S, Radomski SB, Schick E, et al. Multicenter randomized clinical trial comparing surgery and collagen injections for treatment of female stress urinary incontinence. Urology 2005;65(5):898‐904.
Corcos J, Collet JP, Shapiro S, Schick E, Herschorn S, Radomski S, et al. Surgery versus collagen for the treatment of female stress urinary incontinence (SUI): 1 year follow‐up results of a multicentric randomised trial (RCT) (Abstract). Proceedings of the International Continence Society (ICS), 31st Annual Meeting; 2001 Sept 18‐21; Seoul, Korea. 2001:Abstract 248.
Corcos J, Collet JP, Shapiro S, Schick E, Macramallah E, Tessier J, et al. Surgery versus collagen for the treatment of female stress urinary incontinence (SUI): results of a multicentric randomized trial (Abstract). Journal of Urology 2001;165(5 (Suppl)):198.

Goldberg 2001 {published data only}

Goldberg RP, Koduri S, Lobel RW, Culligan PJ, Tomezsko JE, Winkler HA, et al. Long‐term effects of three different anti‐incontinence procedures on the posterior compartment (Abstract). Proceedings of the International Continence Society (ICS), 31st Annual Meeting; 2001 Sept 18‐21; Seoul, Korea. 2001:Abstract 243.

Ishenko 1999 {published data only}

Ishenko AI, Slobodenyuk AI, Chushkov YV. Modified Pereyra and sling procedures in combined surgical treatment in patients with uterine prolapse and stress urinary incontinence ‐ randomized study. European Journal of Obstetrics, Gynecology, & Reproductive Biology 1999;86(Suppl):S15.

Jongen 1999 {published data only}

Jongen VH, Brouwer WK. Comparison of the modified Pereyra procedure using permanent suture material and Burch urethropexy. European Journal of Obstetrics Gynecology and Reproductive Biology 1999;84(1):7‐11.
Jongen VHWM, Brouwer WK. Comparison of the modified Pereyra procedure and Burch urethropexy. Subjective results of a one to six years follow‐up survey (Abstract). International Urogynecology Journal and Pelvic Floor Dysfunction 1997;8:S3.

Koonings 1988 {published data only}

Koonings P, Bergman A, Ballard CA. Combined detrusor instability and stress urinary incontinence: where is the primary pathology?. Gynecologic & Obstetric Investigation 1988;26(3):250‐6.

Morley 1995 {published data only}

Morley R, Cumming J, Birch BRP. Staple colpofixation: a new minimally invasive treatment for stress incontinence (Abstract). Proceedings of the International Continence Society (ICS), 25th Annual Meeting; 1995 Oct 17‐20; Sydney, Australia. 1995:471.

Ramon 1991 {published and unpublished data}

Ramon J, Mekras J, Webster GD. Transvaginal needle suspension procedures for recurrent stress incontinence. Urology 1991;308(6):519‐22.

Salinas 1994 {published data only}

Salinas Casado J, Virseda Chamorro M, Ramirez Fernandez JC, Rapariz Gonzalez M, Esteban Fuertes M, Resel Estevez L. Comparative results of different types of urethropexy in the treatment of stress urinary incontinence in women [Spanish]. Archivos Espanoles de Urologia 1994;47(8):761‐8.
Salinas Casado J, Virseda Chamorro M, Ramirez Fernandez JC, Rapariz Gonzalez M, Esteban Fuertes M, Samblas Garcia R, et al. Effects of urethropexy on urination. A price to pay? [Spanish]. Archivos Espanoles de Urologia 1995;48(7):709‐16.
Virseda Chamorro M, Salinas Casado J, Ramirez Fernandez JC, Rapariz Gonzalez M, Esteban Fuertes M, Nacarino Corbacho L, et al. Impact of bladder irritative symptoms and detrusor instability on the outcome of urethropexy [Spanish]. Archivos Espanoles de Urologia 1995;48(6):595‐601.

Vordermark 1979 {published data only}

Vordermark JS, Brannen GE, Wettlaurfer JN, Modarelli RO. Suprapubic endoscopic vesical neck suspension. Journal of Urology 1979;122(2):165‐7.

Zivkovic 1994 {published data only}

Zivkovic F, Tamussino K, Ralph G, Schied G, Auer‐Grumbach M. Neurourodynamic effects of anterior vaginal repair with or without needle suspension at 1 year (Abstract). Proceedings of the International Continence Society (ICS), 24th Annual Meeting;1994; Prague, Czech Republic. 1994:332.

Abrams 2002

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub‐committee of the International Continence Society. Neurourology and Urodynamics 2002;21(2):167‐78.

Black 1996

Black NA, Downs SH. The effectiveness of surgery for stress incontinence in women: a systematic review. British Journal of Urology 1996;78(4):497‐510.

Black 1997

Black N, Griffiths J, Pope C, Bowling A, Abel P. Impact of surgery for stress incontinence on morbidity: cohort study. BMJ 1997;315(7121):1493‐8.

Bump 1988

Bump RC, Copeland WE, Hurt WG, Fantl JA. Dynamic urethral pressure/profilometry pressure transmission ratio determinations in stress‐incontinent and stress‐continent subjects. American Journal of Obstetrics & Gynecology 1988;159(3):749‐55.

Dean 2006

Dean NM, Ellis G, Wilson PD, Herbison GP. Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/14651858.CD002239.pub2]

Downs 1996

Downs S, Black N. Systematic review of the literature on the effectiveness of surgery for stress incontinence in women. Report 21. Public Health and Policy Publications. London: Department of Public Health and Policy Publications, London School of Hygiene and Tropical Medicine, 1996:1‐93. [ISSN 0962‐6115]

Fantl 1996

Fantl JA, Newman DK, Colling J, DeLancey JOL, Keeys C, Loughery R, et al. Urinary Incontinence in Adults: Acute and Chronic Management. 2. Washington: Agency for Health Care Policy and Research, US Government Printing Office, 1996.

Glazener 2001

Glazener CMA, Cooper K. Anterior vaginal repair for urinary incontinence in women. Cochrane Database of Systematic Reviews 2001, Issue 1. [DOI: 10.1002/14651858.CD001755]

Higgins 2003

Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60.

Higgins 2011

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org. Chichester, UK: John Wiley & Sons, Ltd.

Hilton 1983

Hilton P, Stanton SL. Urethral pressure measurement by microtransducer: the results in symptom‐free women and in those with genuine stress incontinence. British Journal of Obstetrics & Gynaecology 1983;90(10):919‐33.

Jarvis 1994

Jarvis GJ. Surgery for genuine stress incontinence. British Journal of Obstetrics & Gynaecology 1994;101(5):371‐4.

Kelleher 1997

Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. British Journal of Obstetrics & Gynaecology 1997;104(12):1374‐9.

Kirchin 2012

Kirchin V, Page T, Keegan PE, Atiemo K, Cody JD, McClinton S. Urethral injection therapy for urinary incontinence in women. Cochrane Database of Systematic Reviews 2012, Issue 2. [DOI: 10.1002/14651858.CD003881.pub3]

Lapitan 2012

Lapitan MCM, Cody JD. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2012, Issue 6. [DOI: 10.1002/14651858.CD002912.pub5]

Leach 1997

Leach GE, Dmochowski RR, Appell RA, Blaivas JG, Hadley HR, Luber KM, et al. Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. The American Urological Association. Journal of Urology 1997;158(3 Pt 1):875‐80.

Lose 1998

Lose G, Fantl JA, Victor A, Walter S, Wells TL. Outcome measures for research in adult women with symptoms of lower urinary tract dysfunction. Neurourology and Urodynamics 1998;17(3):255‐62.

Meyer 1994

Meyer S, De Grandi P, Schmidt N, Sanzeni W, Spinosa JP. Urodynamic parameters in patients with slight and severe genuine stress incontinence: is the stress profile useful?. Neurourology and Urodynamics 1994;13(1):21‐8.

Reference Manager 2012 [Computer program]

Thomson Reuters. Reference Manager Professional Edition. Version 12. New York: Thomson Reuters, 2012.

Rehman 2011

Rehman H, Bezerra CCB, Bruschini H, Cody JD. Traditional suburethral sling operations for urinary incontinence in women. Cochrane Database of Systematic Reviews 2011, Issue 1. [DOI: 10.1002/14651858.CD001754.pub3]

Swift 1995

Swift SE, Ostergard DR. Evaluation of current urodynamic testing methods in the diagnosis of genuine stress incontinence. Obstetrics and Gynecology 1995;86(1):85‐91.

References to other published versions of this review

Glazener 2004

Glazener CMA, Cooper K. Bladder neck needle suspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2004, Issue 2. [DOI: 10.1002/14651858.CD003636.pub2]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Jump to:

Athanassopoulos 1996

Methods

Quasi‐randomised RCT (by birth date)
Blinding not mentioned
No power calculation
ITT analysis
Follow‐up 8 to 27 months

Participants

n = 51. No withdrawals mentioned
Inclusion criteria: GSI (urodynamic diagnosis); combined primary and recurrent. Includes those with previous surgery and with prolapse
Mean age: 50 years (20 to 78), 50.9% menopausal, 14% with previous pelvic operations
No baseline comparison of treatment groups
Single‐centre, university‐based hospital, Greece

Interventions

(I) Burch (27)
(II) Stamey (24)
Description of both procedures referenced. All performed by 1 surgeon

Outcomes

Cure = complete freedom from SUI at 8 to 27 months
Failure = persistent or recurrent SUI at 8 to 27 months
Urinary retention not defined
Failure rate: (I) 7/27; (II) 7/24
Number not improved: (I) 3/27; (I): 4/24
Length of stay: (I) 5.8 days (range 4 to 11); (I): 3 (6 to 12)
Complications (haematoma, abscess): (I) 6/27; (II) 4/24
Urinary retention: (I) 2/27; (II) 3/24
Urgency: (I) 3/27; (II) 1/24
Urodynamic data also given

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Date of birth

Allocation concealment (selection bias)

High risk

C ‐ Inadequate

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Not mentioned

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No drop‐outs reported

Bergman 1989a

Methods

RCT
Patients and surgeons randomly allocated (using randomisation tables) to 1 of 3 operations.
Follow‐up at 3 and 12 months, and 5 years
20 women lost to follow‐up at 12 months were not reported

Participants

127 women recruited, results reported for 107 at 12 months. Results for 64 at 5 years out of 78 cured at 1 year
Groups stated to be comparable in mean age, parity and menopausal status but data not given
53 pre‐menopausal, 74 post‐menopausal
Inclusion: GSI (urodynamic diagnosis); minor cystocele only; postmenopausal women given oestrogens before and after surgery
Exclusion criteria: significant prolapse, other gynaecological disease or operations; previously failed incontinence surgery
Single‐centre, university‐based hospital, urogynaecology unit, USA

Interventions

(I) Anterior vaginal repair (colporrhaphy) (35) (n = 30 at 5 years)
(II) Needle (modified Pereyra procedure) (34) (n = 30 at 5 years)
(III) Colposuspension (Burch urethropexy) (38) (n = 33 at 5 years)

Outcomes

Cure defined as no loss of urine in history or on urodynamic investigation
Failure rate: (I) at 3 months 7/35, at 12 months 13/35, at 5 years 19/30
(II) at 3 months 6/34, at 12 months 12/34, at 5 years 17/30
(III) at 3 months 3/38, at 12 months 4/38, at 5 years 6/33
Failure rate (sensitivity analysis): (I) 24/35; (II) 21/34; (III) 11/38
No subsequent voiding problems in any patient
Postoperative bacteriuria equally frequent in all groups
3 developed detrusor instability (groups not specified); 6 developed prolapse ((I) 3; (II) 2; (III) 1)
Urodynamic measurements reported before and 12 months and 5 years after operation

Notes

Sensitivity analysis at 5 years for 107 assuming missing 14 were failures and including 29 already failed at 1 year

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation tables

Allocation concealment (selection bias)

Unclear risk

B ‐ Unclear

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Not mentioned

Incomplete outcome data (attrition bias)
All outcomes

High risk

20 women lost to follow‐up at 1 year, 43 at 5 years

Bergman 1989b

Methods

RCT
Follow‐up at 3 and 12 months
Patients and surgeons randomly allocated (using randomisation tables) to 1 of 3 operations
3 women excluded for technical reasons, 41 lost to follow‐up: 298 women reported in the study

Participants

342 women (298 reported)
Mean age 57 years (range 31 to 80); parity 3 (1 to 13); 191 postmenopausal, 151 premenopausal. Groups comparable at baseline but data not given
Postmenopausal women given oestrogens before and after surgery
Inclusion criteria: urodynamic diagnosis of primary GSI, stable bladder and pelvic relaxation (prolapse)
Exclusion criteria: previous incontinence surgery, detrusor instability, gynaecological complications other than prolapse
Single‐centre, university‐based hospital, urogynaecology unit, USA

Interventions

(I) Anterior vaginal repair (99)
(II) Needle (revised Pereyra procedure) (98)
(III) Colposuspension (Burch retropubic urethropexy) (101)

Outcomes

Failure rate: (I) at 3 months 20/99, at 12 months 31/99
(II) at 3 months 19/98, at 12 months 29/98
(III) at 3 months 11/101, at 12 months 13/101
No postoperative voiding problems
Urodynamic measurements reported before and 12 months after operation

Notes

Tertiary referral centre. No power calculation

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Randomisation tables

Allocation concealment (selection bias)

Unclear risk

B ‐ Unclear

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Not mentioned

Incomplete outcome data (attrition bias)
All outcomes

High risk

44 women lost to follow‐up

Di Palumbo 2003

Methods

RCT
2:1 randomisation using sealed envelopes
Follow‐up: 280 to 1670 days (at 1, 3, 6, 12, 18 and 24 months, then yearly)

Participants

80 women with SUI + urethrocystocele (anterior prolapse) grade 3 or 4
Age: (I) mean 59.8 years (range 41 to 79), (II) 60.6 (39 to 78)
Concomitant vaginal hysterectomy: (I) 47/52, (II) 26/28
Inclusion criteria: prolapse defect assessed (apical, central, lateral), SUI, UUI, mixed incontinence and overactive bladder diagnosed with Q tip test, stress test, 1‐hour pad test and urodynamics. If urgency, bladder training and anticholinergic treatment before surgery.

Interventions

(I) Anterior repair (Nicholls) (52)
(II) 4‐corner bladder and urethral retropubic suspension (Raz) with thin polypropylene mesh in the spiral suture (28)

Outcomes

SUI (failed): (I) 14/52, (II) 4/28 (assumed to be after first year)
New rectocoele at 6 months: (I) 3/52, (II) 5/28
Urge incontinence: (I) 12/52, (II) 5/28
Frequency of urination: (I) 10/52, (II) 2/28
Urinary retention in first 10 days: (I) 1/52, (II) 1/28
Long‐term retention: (I) 0/52, (II) 0/28
Time to spontaneous voiding: (I) 3.62 days (range 2 to 9), (II) 4.78 (3 to 9)
Postoperative hospital stay: (I) mean 6 days (range 4 to 20), (II) 5 (4 to 34) (NS)
Adverse effects: (I) 0/52, (II) 1/28 (sepsis, removal of stitches and prolonged hospital stay)

Notes

Women comparable at baseline for age, diabetes, respiratory problems, obstetric history, concomitant vaginal hysterectomy

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

RCT

Allocation concealment (selection bias)

Low risk

A ‐ Adequate (sealed envelopes)

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No drop‐outs reported

German 1992

Methods

RCT. Method not described. 2 arms
Blinding not mentioned
ITT analysis
Follow‐up mean 2 years (12 to 44 months)

Participants

n = 50. No withdrawals
Inclusion criteria: GSI (urodynamic diagnosis); both primary and recurrent UI. No mixed UI
Mean age: 50/53; mean weight: 68.4/70.9 kg
Baseline comparison of groups matched to age and weight
Previous surgery: (I) 11; (II) 10
Single‐centre, Department of Urology, UK

Interventions

(I) Colposuspension (vagina/obturator shelf repair) (24)
(II) Needle suspension, modified Stamey (26)
Both techniques described
Surgeon not mentioned

Outcomes

Success = complete dryness or occasional incontinence
Failure rate at 12 to 44 months: (I) 7/24; (II) 11/26
Length of stay: (I) 8.3 days; (II) 7 days
Peri‐operative infection: I: 6/24; II: 3/26
Postoperative pain: (I) 11/24; (II) 19/26
Voiding problems (short‐term): (I) 4/24; (II) 0/26
Voiding problems (long‐term): (I) 0/24; (II) 0/26
Time to normal activity: (I) 10.4 weeks; (II) 7.9 weeks
New urgency: (I) 1/24; (II) 2/26

Notes

Separate analysis of primary and recurrent cases possible

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

RCT

Allocation concealment (selection bias)

Unclear risk

B ‐ Unclear

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Not mentioned

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No drop‐outs reported

Gilja 1998

Methods

RCT by open randomisation list (3 arms)
Blinding not mentioned
Not ITT
Follow‐up 3 years

Participants

n = 204, 58 lost to follow‐up due to war
Inclusion criteria: GSI (urodynamic diagnosis)
Exclusion criteria: previous urological or gynaecological operations for incontinence
Mean age 36 years (28 to 48); mean parity 3.1 (1 to 8)
Number premenopausal: 63
Baseline comparison of groups similar in age and parity
Single‐centre, general hospital, Department of Urology, Croatia

Interventions

(I) Colposuspension (Burch) (56)
(II) Needle (transvaginal Burch/Gilja) (44)
(III) Needle (Raz) (46)
Burch and Raz described and referenced. Gilja = combination of open abdominal suspension and needle but classed as a needle suspension

Single surgeon for all

Outcomes

Subjective UI in 1st year: (I) 2/56; (II) 1/44; (III) 3/46
Subjective UI at 3 years: (I) 4/56; (II) 4/44; (III) 7/46
Objective UI in 1st year: (I) 3/56; (II) 5/44; (III) 6/46
Objective UI in 3rd year: (I) 6/56; (II) 6/44; (III) 9/46
Urge incontinence at 3 years: (I) 2/56; (II) 3/44; (III) 5/46

Notes

With additional information from author
Author emphasised strict evaluation of results for cure

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Open randomisation list

Allocation concealment (selection bias)

High risk

C ‐ Inadequate (open list)

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Not mentioned

Incomplete outcome data (attrition bias)
All outcomes

High risk

58 drop‐outs (due to war)

Hilton 1989

Methods

RCT. Follow‐up at 2, 3, 12 and 24 months. Women allocated to 1 of 2 interventions by random tables. All women available at follow‐up

Participants

20 women recruited, 10 in each arm of the study
Inclusion criteria: GSI (urodynamic diagnosis), vaginal narrowing, postsurgical scar, unsuitable for colposuspension
Exclusion criteria: not stated
Groups comparable for age, parity and number of previous surgical incontinence procedures
Age: mean 57 to 54 years (range 42 to 75)
Menopausal status not reported

Single‐centre, Department of Obstetrics and Gynaecology, UK

Interventions

(I) Needle suspension (Stamey) (10)
(II) Sling (porcine dermis) (10)

Outcomes

Cure = objective (urodynamic diagnosis, pad test) at 3 months and subjective at 24 months
Failure rate (objective) at 3 months: (I) 2/10; (II) 1/10
Failure rate (subjective) at 24 months: (I) 3/10; (II) 1/10
Postoperative complications: (I) 2/10; (II) 9/10 (operative blood loss, pyrexia, infective complications, permanent suprapubic catheter)
Hospital stay: (I) 7 days (0.3); (II) 20 (12.9)
Voiding problems at 3 months: (I) 2/10; (II) 4/10
Urge incontinence: (I) 3/10; (II) 5/10
Detrusor instability: (I) 1/10; (II) 2/10
Late complications not reported

Urodynamic data also given

Notes

Pad test at 12 and 24 months stated but not reported

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random tables

Allocation concealment (selection bias)

Unclear risk

B ‐ Unclear

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Not mentioned

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No drop‐outs

Mundy 1983

Methods

Quasi‐randomised RCT (alternate allocation)
Stratification between primary and recurrent GSI. 2 arms
Blinding not mentioned
No power calculation
ITT analysis
Follow‐up minimum 1 year

Participants

n = 51. No withdrawals
Inclusion criteria: GSI (urodynamic diagnosis), combined primary and recurrent UI. No mixed UI
Mean age 48 years (29 to 70). No baseline comparison of groups
Single‐centre, Department of Urology, UK

Interventions

(I) Colposuspension (Burch) (26)
(II) Needle (modified Stamey) (25)

Colposuspension referenced; modified Stamey described

Single surgeon for all cases

Outcomes

Subjective cure = not defined
Objective cure = negative nappy test and video UDS
Failure rate (subjective) at 12 months: (I) 3/26; (II) 6/25
Failure rate (objective) at 12 months: (I) 6/26; (II) 15/25
DI: (I) 2/26; (II) 5/25
Voiding difficulty: (I) 3/26; (II) 6/25
Peri‐operative complications (UTI, stitch removal, Dacron sheath removal): (I) 0/26; (II) 10/25
(II) 3 of the 10 needed removal of suprapubic Dacron buffer

Notes

Colposuspension described as Burch
Cannot do separate analysis for recurrent GSI alone

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

High risk

Alternation

Allocation concealment (selection bias)

High risk

C ‐ Inadequate

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Not mentioned

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No withdrawals

Palma 1985

Methods

RCT, method not described
Author replied patients, care givers and assessors were blinded
Not mentioned if ITT analysis
Follow‐up: (I) mean 34 months, (range 19 to 56); (II) 21 (2 to 44)

Participants

n = 70. No withdrawals mentioned
Previous surgery (Kelly or MMK): (I) 3/30, (II) 10/40
Urodynamics used to confirm SUI if in doubt
Age: (I) mean 46 years (range 28 to 69); (II) 44 (26 to 67)
Inclusion/exclusion not mentioned
No statistical baseline comparisons of groups
Single‐centre. Department of Obstetrics and Gynaecology, university‐based hospital, Campinas, Brazil

Interventions

(I) MMK (30)
(II) Needle suspension (Stamey) (40)
Procedures described
Surgeon not mentioned

Outcomes

Not cured in first year: (I) 4/30, (II) 1/20
Not cured after first year: (I) 7/30, (II) 10/20
Not improved in first year: (I) 2/30, (II) 1/20
New urge or urge incontinence: (I) 0/30, (II) 2/20
New detrusor overactivity: (I) 0/30, (II) 1/20
Operating time: (I) 30 minutes, (II) 35 minutes
Length of stay: (I) 3 days, (II) 2 days
Voiding dysfunction: (I) 0/30, (II) 1/20

Notes

Abstract
Correspondence from author to clarify if randomised. Extra data also obtained

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

RCT

Allocation concealment (selection bias)

Unclear risk

B ‐ Unclear

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Not mentioned

Incomplete outcome data (attrition bias)
All outcomes

High risk

20 participants not reported

Stein 1991

Methods

RCT of 2 different suture materials. Method of randomisation not described
2 arms, blinding not mentioned, no power calculation
Follow‐up 6 months

Participants

24 women, 4 excluded because not followed up
Inclusion criteria: GSI (urodynamic diagnosis), no urinary tract infection, undergoing needle suspension
Exclusion criteria: previous incontinence surgery, pelvic pain
Groups stated to be comparable (socioeconomic, race, age)
Age (I) 46 years (range 30 to 59); (II) 49 (35 to 67)

Interventions

(I) CV‐0 polytetrafluoro‐ethylene (Goretex) suture (9)
(II) #1 polypropylene suture (11)

Outcomes

Pain and continence. Cure defined as no incontinence, no use of pads or medication, good = slight incontinence, improved = occasional pad or drug use, failed = unimproved or worse
Pain (n, mean score, SD) at 1 month: I: 9, 1 (SD 1.5); II: 10, 1.6 (1.31)
Pain (n, mean score, SD) at 3 months: I: 9, 0.33 (0.71); II: 11, 1.25 (1.2)
Failed at 3 months: (I) 0/9; (II) 3/11
Not improved at 3 months: (I) 0/9; (II) 1/11
Urge incontinence: (I) 0/9; (II) 2/11
Cost of Goretex (I) very high compared to (II)

Notes

Type of operation stated not to have affected randomisation or outcomes but data not given to assess this. Raz urethropexy, Raz 4‐corner repair or Gittes urethropexy

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

RCT

Allocation concealment (selection bias)

Unclear risk

B ‐ Unclear

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Not mentioned

Incomplete outcome data (attrition bias)
All outcomes

High risk

4 excluded because not followed up

BMI = body mass index; DI = detrusor instability (now DO = detrusor overactivity); GSI = genuine stress incontinence (now USI = urodynamic stress incontinence); ITT = intention‐to‐treat; kg = kilograms; MMK = Marshall‐Marchetti‐Krantz; NS = not significant; PFMT = pelvic floor muscle training; RCT = randomised controlled trial; SUI = stress urinary incontinence (symptom diagnosis); TVT = tension‐free vaginal tape; w = week(s); SD = standard deviation; UDS = urodynamics; UI = urinary incontinence; UUI= Urgency Urinary Incontinence; UTI = urinary tract infection; VAS = visual analogue score

Characteristics of excluded studies [ordered by study ID]

Jump to:

Study

Reason for exclusion

Bump 1995

RCT, but women had prolapse and NO incontinence
Interventions: anterior repair versus needle suspension

Bump 1996

RCT, but women were not incontinent
Interventions: needle versus endopelvic fascia plication

Colombo 1997

RCT, but women did not all have incontinence
Interventions: needle (Pereyra) versus posterior pubourethral ligament plication

Corcos 2001

RCT, but data not presented separately for each type of surgery
Interventions: injectables versus surgery (6 needle bladder neck suspensions, 24 sling, 24 Burch)

Goldberg 2001

RCT, but of mesh versus no mesh for prolapse. This paper reports outcomes of women who had concomitant incontinence procedures, but were not randomised to these operations

Ishenko 1999

Randomisation and groups unclear ("randomised by age"). Excluded as attempts to contact authors unsuccessful and insufficient information given in abstract
Interventions: vaginal hysterectomy, modified Pereyra procedure, anterior and posterior repair versus vaginal hysterectomy, sling procedure with Mersilene mesh, anterior and posterior repair

Jongen 1999

Not RCT
Interventions: colposuspension (Burch) versus needle suspension (Pereyra) for stress incontinence

Koonings 1988

RCT, but trial not focused on needle suspension alone
Intervention: surgery (mixed types, including needle suspensions) plus drugs versus surgery (mixed) alone

Morley 1995

RCT of 54 women with urodynamic stress urinary incontinence
Interventions: Stamey endoscopic bladder neck suspension (needle) versus staple colpofixation, described as a new technique
Excluded as attempts to obtain more information from authors unsuccessful, and insufficient data given in abstract

Ramon 1991

Not RCT
Interventions: Stamey, Raz. Operation chosen by surgeon's preference

Salinas 1994

Not RCT
Interventions: Kelly, Raz, Marshall‐Marchetti‐Krantz, Burch, simplified Ramirez

Vordermark 1979

Not RCT
Interventions: needle (Pereyra/Stamey/Mason) versus open abdominal retropubic suspension (Marshall‐Marchetti‐Krantz)

Zivkovic 1994

Not RCT
Interventions: anterior vaginal repair with or without needle suspension

RCT = randomised controlled trial

Data and analyses

Open in table viewer
Comparison 1. Needle suspension versus open abdominal retropubic suspension

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

5

517

Risk Ratio (M‐H, Fixed, 95% CI)

1.70 [1.11, 2.60]

Analysis 1.1

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

1.1 Objective/genuine stress incontinence (only)

5

517

Risk Ratio (M‐H, Fixed, 95% CI)

1.70 [1.11, 2.60]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

7

610

Risk Ratio (M‐H, Fixed, 95% CI)

2.00 [1.47, 2.72]

Analysis 1.2

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

2.1 Objective/genuine stress incontinence (only)

7

610

Risk Ratio (M‐H, Fixed, 95% CI)

2.00 [1.47, 2.72]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number not improved (worse or unchanged) within first year Show forest plot

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.07, 7.73]

Analysis 1.3

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 3 Number not improved (worse or unchanged) within first year.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 3 Number not improved (worse or unchanged) within first year.

3.1 Objective/genuine stress incontinence (only)

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.07, 7.73]

3.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number not improved (worse or unchanged) after first year Show forest plot

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.37, 6.04]

Analysis 1.4

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 4 Number not improved (worse or unchanged) after first year.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 4 Number not improved (worse or unchanged) after first year.

4.1 Objective/genuine stress incontinence (only)

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.37, 6.04]

4.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Urge symptoms or urge incontinence Show forest plot

4

297

Risk Ratio (M‐H, Fixed, 95% CI)

1.80 [0.71, 4.56]

Analysis 1.5

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 5 Urge symptoms or urge incontinence.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 5 Urge symptoms or urge incontinence.

5.1 Objective/genuine stress incontinence (only)

4

297

Risk Ratio (M‐H, Fixed, 95% CI)

1.80 [0.71, 4.56]

5.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Voiding dysfunction after 3 months Show forest plot

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

2.12 [0.81, 5.55]

Analysis 1.6

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 6 Voiding dysfunction after 3 months.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 6 Voiding dysfunction after 3 months.

6.1 Objective/genuine stress incontinence (only)

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

2.12 [0.81, 5.55]

6.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Detrusor overactivity (objective diagnosis by urodynamics) Show forest plot

2

101

Risk Ratio (M‐H, Fixed, 95% CI)

2.91 [0.73, 11.58]

Analysis 1.7

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).

7.1 Objective/genuine stress incontinence (only)

2

101

Risk Ratio (M‐H, Fixed, 95% CI)

2.91 [0.73, 11.58]

7.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 New or persistent prolapse Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

2.24 [0.21, 23.57]

Analysis 1.8

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 8 New or persistent prolapse.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 8 New or persistent prolapse.

8.1 Objective/genuine stress incontinence (only)

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

2.24 [0.21, 23.57]

8.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Peri‐operative surgical complications Show forest plot

3

152

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.83]

Analysis 1.9

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 9 Peri‐operative surgical complications.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 9 Peri‐operative surgical complications.

9.1 Objective/genuine stress incontinence (only)

3

152

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.83]

9.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Length of stay/time to return to normal function Show forest plot

Other data

No numeric data

Analysis 1.10

Study

Needle suspension

Abdominal suspension

Athanassopoulos 1996

Mean length of stay: 3 days (range 6 to 12)

Mean length of stay: 5.8 days (range 4 to 11)

German 1992

Mean length of stay: 7 days
Time to return to normal activity: 7 weeks

Mean length of stay: 8.3 days
Time to return to normal activity: 10.4 weeks



Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 10 Length of stay/time to return to normal function.

Open in table viewer
Comparison 2. Needle suspension versus open abdominal retropubic suspension (no previous surgery)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

3

417

Risk Ratio (M‐H, Fixed, 95% CI)

2.05 [1.20, 3.50]

Analysis 2.1

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.

1.1 Objective/genuine stress incontinence (only)

3

417

Risk Ratio (M‐H, Fixed, 95% CI)

2.05 [1.20, 3.50]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

3

408

Risk Ratio (M‐H, Fixed, 95% CI)

2.37 [1.54, 3.66]

Analysis 2.2

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.

2.1 Objective/genuine stress incontinence (only)

3

408

Risk Ratio (M‐H, Fixed, 95% CI)

2.37 [1.54, 3.66]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Urge symptoms or urge incontinence Show forest plot

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

2.49 [0.55, 11.30]

Analysis 2.3

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 3 Urge symptoms or urge incontinence.

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 3 Urge symptoms or urge incontinence.

3.1 Objective/genuine stress incontinence (only)

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

2.49 [0.55, 11.30]

3.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 New or persistent prolapse Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

2.24 [0.21, 23.57]

Analysis 2.4

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 4 New or persistent prolapse.

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 4 New or persistent prolapse.

4.1 Objective/genuine stress incontinence (only)

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

2.24 [0.21, 23.57]

4.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 3. Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.55, 2.29]

Analysis 3.1

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.

1.1 Objective/genuine stress incontinence (only)

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.55, 2.29]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

1.61 [1.04, 2.49]

Analysis 3.2

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.

2.1 Objective/genuine stress incontinence (only)

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

1.61 [1.04, 2.49]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number not improved (worse or unchanged) within first year Show forest plot

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.07, 7.73]

Analysis 3.3

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 3 Number not improved (worse or unchanged) within first year.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 3 Number not improved (worse or unchanged) within first year.

3.1 Objective/genuine stress incontinence (only)

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.07, 7.73]

3.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number not improved (worse or unchanged) after first year Show forest plot

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.37, 6.04]

Analysis 3.4

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 4 Number not improved (worse or unchanged) after first year.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 4 Number not improved (worse or unchanged) after first year.

4.1 Objective/genuine stress incontinence (only)

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.37, 6.04]

4.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Urge symptoms or urge incontinence Show forest plot

3

151

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.42, 4.59]

Analysis 3.5

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 5 Urge symptoms or urge incontinence.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 5 Urge symptoms or urge incontinence.

5.1 Objective/genuine stress incontinence (only)

3

151

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.42, 4.59]

5.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Voiding dysfunction after 3 months Show forest plot

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

2.12 [0.81, 5.55]

Analysis 3.6

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 6 Voiding dysfunction after 3 months.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 6 Voiding dysfunction after 3 months.

6.1 Objective/genuine stress incontinence (only)

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

2.12 [0.81, 5.55]

6.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Detrusor overactivity (objective diagnosis by urodynamics) Show forest plot

2

101

Risk Ratio (M‐H, Fixed, 95% CI)

2.91 [0.73, 11.58]

Analysis 3.7

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).

7.1 Objective/genuine stress incontinence (only)

2

101

Risk Ratio (M‐H, Fixed, 95% CI)

2.91 [0.73, 11.58]

7.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Peri‐operative surgical complications Show forest plot

3

152

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.83]

Analysis 3.8

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 8 Peri‐operative surgical complications.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 8 Peri‐operative surgical complications.

8.1 Objective/genuine stress incontinence (only)

3

152

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.83]

8.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 4. Needle suspension versus suburethral sling operations

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

2.0 [0.21, 18.69]

Analysis 4.1

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

1.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

2.0 [0.21, 18.69]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.37, 24.17]

Analysis 4.2

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

2.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.37, 24.17]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Urge symptoms or urge incontinence Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.19, 1.86]

Analysis 4.3

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 3 Urge symptoms or urge incontinence.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 3 Urge symptoms or urge incontinence.

3.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.19, 1.86]

3.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Voiding dysfunction after 3 months Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.12, 2.14]

Analysis 4.4

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 4 Voiding dysfunction after 3 months.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 4 Voiding dysfunction after 3 months.

4.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.12, 2.14]

4.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Detrusor overactivity (objective diagnosis by urodynamics) Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.05, 4.67]

Analysis 4.5

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 5 Detrusor overactivity (objective diagnosis by urodynamics).

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 5 Detrusor overactivity (objective diagnosis by urodynamics).

5.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.05, 4.67]

5.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Peri‐operative surgical complications Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.06, 0.78]

Analysis 4.6

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 6 Peri‐operative surgical complications.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 6 Peri‐operative surgical complications.

6.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.06, 0.78]

6.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Length of inpatient stay Show forest plot

1

20

Mean Difference (IV, Fixed, 95% CI)

‐13.0 [‐19.00, ‐5.00]

Analysis 4.7

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 7 Length of inpatient stay.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 7 Length of inpatient stay.

7.1 Objective/genuine stress incontinence (only)

1

20

Mean Difference (IV, Fixed, 95% CI)

‐13.0 [‐19.00, ‐5.00]

7.2 Subjective stress incontinence (only)

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Mixed incontinence

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 5. Needle suspension versus anterior vaginal repair

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

2

266

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.63, 1.46]

Analysis 5.1

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

1.1 Objective/genuine stress incontinence (only)

2

266

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.63, 1.46]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

3

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.64, 1.16]

Analysis 5.2

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

2.1 Objective/genuine stress incontinence (only)

2

257

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.68, 1.26]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.19, 1.46]

3 Urge symptoms or urge incontinence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 5.3

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 3 Urge symptoms or urge incontinence.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 3 Urge symptoms or urge incontinence.

3.1 Objective/genuine stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Subjective stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Voiding dysfunction after 3 months Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 5.4

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 4 Voiding dysfunction after 3 months.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 4 Voiding dysfunction after 3 months.

4.1 Objective/genuine stress incontinence (only)

2

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Subjective stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Peri‐operative surgical complications Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 5.5

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 5 Peri‐operative surgical complications.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 5 Peri‐operative surgical complications.

5.1 Objective/genuine stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 Subjective stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 Mixed incontinence

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 New or persistent prolapse Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Analysis 5.6

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 6 New or persistent prolapse.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 6 New or persistent prolapse.

6.1 Objective/genuine stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 Subjective stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Mixed incontinence

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 6. One type of needle suspension versus another type of needle suspension

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

2.87 [0.31, 26.56]

Analysis 6.1

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

1.1 Raz versus transvaginal Burch (Gilja)

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

2.87 [0.31, 26.56]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [0.53, 5.32]

Analysis 6.2

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

2.1 Raz versus transvaginal Burch (Gilja)

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [0.53, 5.32]

3 Urge symptoms or urge incontinence Show forest plot

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.59 [0.40, 6.28]

Analysis 6.3

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 3 Urge symptoms or urge incontinence.

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 3 Urge symptoms or urge incontinence.

3.1 Raz versus transvaginal Burch (Gilja)

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.59 [0.40, 6.28]

Open in table viewer
Comparison 7. One type of suture versus another type of suture

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.01, 2.94]

Analysis 7.1

Comparison 7 One type of suture versus another type of suture, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 7 One type of suture versus another type of suture, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

2 Number not improved (worse or unchanged) within first year Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.4 [0.02, 8.78]

Analysis 7.2

Comparison 7 One type of suture versus another type of suture, Outcome 2 Number not improved (worse or unchanged) within first year.

Comparison 7 One type of suture versus another type of suture, Outcome 2 Number not improved (worse or unchanged) within first year.

3 Urge symptoms or urge incontinence Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.24 [0.01, 4.44]

Analysis 7.3

Comparison 7 One type of suture versus another type of suture, Outcome 3 Urge symptoms or urge incontinence.

Comparison 7 One type of suture versus another type of suture, Outcome 3 Urge symptoms or urge incontinence.

4 Pain score Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

Analysis 7.4

Comparison 7 One type of suture versus another type of suture, Outcome 4 Pain score.

Comparison 7 One type of suture versus another type of suture, Outcome 4 Pain score.

4.1 At one month

1

19

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.87, 0.67]

4.2 At three months

1

20

Mean Difference (IV, Fixed, 95% CI)

‐0.92 [‐1.77, ‐0.07]

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
Figures and Tables -
Analysis 1.1

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.
Figures and Tables -
Analysis 1.2

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 3 Number not improved (worse or unchanged) within first year.
Figures and Tables -
Analysis 1.3

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 3 Number not improved (worse or unchanged) within first year.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 4 Number not improved (worse or unchanged) after first year.
Figures and Tables -
Analysis 1.4

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 4 Number not improved (worse or unchanged) after first year.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 5 Urge symptoms or urge incontinence.
Figures and Tables -
Analysis 1.5

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 5 Urge symptoms or urge incontinence.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 6 Voiding dysfunction after 3 months.
Figures and Tables -
Analysis 1.6

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 6 Voiding dysfunction after 3 months.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).
Figures and Tables -
Analysis 1.7

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 8 New or persistent prolapse.
Figures and Tables -
Analysis 1.8

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 8 New or persistent prolapse.

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 9 Peri‐operative surgical complications.
Figures and Tables -
Analysis 1.9

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 9 Peri‐operative surgical complications.

Study

Needle suspension

Abdominal suspension

Athanassopoulos 1996

Mean length of stay: 3 days (range 6 to 12)

Mean length of stay: 5.8 days (range 4 to 11)

German 1992

Mean length of stay: 7 days
Time to return to normal activity: 7 weeks

Mean length of stay: 8.3 days
Time to return to normal activity: 10.4 weeks

Figures and Tables -
Analysis 1.10

Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 10 Length of stay/time to return to normal function.

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.
Figures and Tables -
Analysis 2.1

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.
Figures and Tables -
Analysis 2.2

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 3 Urge symptoms or urge incontinence.
Figures and Tables -
Analysis 2.3

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 3 Urge symptoms or urge incontinence.

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 4 New or persistent prolapse.
Figures and Tables -
Analysis 2.4

Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 4 New or persistent prolapse.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.
Figures and Tables -
Analysis 3.1

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.
Figures and Tables -
Analysis 3.2

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 3 Number not improved (worse or unchanged) within first year.
Figures and Tables -
Analysis 3.3

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 3 Number not improved (worse or unchanged) within first year.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 4 Number not improved (worse or unchanged) after first year.
Figures and Tables -
Analysis 3.4

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 4 Number not improved (worse or unchanged) after first year.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 5 Urge symptoms or urge incontinence.
Figures and Tables -
Analysis 3.5

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 5 Urge symptoms or urge incontinence.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 6 Voiding dysfunction after 3 months.
Figures and Tables -
Analysis 3.6

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 6 Voiding dysfunction after 3 months.

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).
Figures and Tables -
Analysis 3.7

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 8 Peri‐operative surgical complications.
Figures and Tables -
Analysis 3.8

Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 8 Peri‐operative surgical complications.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
Figures and Tables -
Analysis 4.1

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 2 Number not cured (worse, unchanged or improved) after first year.
Figures and Tables -
Analysis 4.2

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 3 Urge symptoms or urge incontinence.
Figures and Tables -
Analysis 4.3

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 3 Urge symptoms or urge incontinence.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 4 Voiding dysfunction after 3 months.
Figures and Tables -
Analysis 4.4

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 4 Voiding dysfunction after 3 months.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 5 Detrusor overactivity (objective diagnosis by urodynamics).
Figures and Tables -
Analysis 4.5

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 5 Detrusor overactivity (objective diagnosis by urodynamics).

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 6 Peri‐operative surgical complications.
Figures and Tables -
Analysis 4.6

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 6 Peri‐operative surgical complications.

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 7 Length of inpatient stay.
Figures and Tables -
Analysis 4.7

Comparison 4 Needle suspension versus suburethral sling operations, Outcome 7 Length of inpatient stay.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
Figures and Tables -
Analysis 5.1

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 2 Number not cured (worse, unchanged or improved) after first year.
Figures and Tables -
Analysis 5.2

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 3 Urge symptoms or urge incontinence.
Figures and Tables -
Analysis 5.3

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 3 Urge symptoms or urge incontinence.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 4 Voiding dysfunction after 3 months.
Figures and Tables -
Analysis 5.4

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 4 Voiding dysfunction after 3 months.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 5 Peri‐operative surgical complications.
Figures and Tables -
Analysis 5.5

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 5 Peri‐operative surgical complications.

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 6 New or persistent prolapse.
Figures and Tables -
Analysis 5.6

Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 6 New or persistent prolapse.

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
Figures and Tables -
Analysis 6.1

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.
Figures and Tables -
Analysis 6.2

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 3 Urge symptoms or urge incontinence.
Figures and Tables -
Analysis 6.3

Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 3 Urge symptoms or urge incontinence.

Comparison 7 One type of suture versus another type of suture, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
Figures and Tables -
Analysis 7.1

Comparison 7 One type of suture versus another type of suture, Outcome 1 Number not cured (worse, unchanged or improved) within first year.

Comparison 7 One type of suture versus another type of suture, Outcome 2 Number not improved (worse or unchanged) within first year.
Figures and Tables -
Analysis 7.2

Comparison 7 One type of suture versus another type of suture, Outcome 2 Number not improved (worse or unchanged) within first year.

Comparison 7 One type of suture versus another type of suture, Outcome 3 Urge symptoms or urge incontinence.
Figures and Tables -
Analysis 7.3

Comparison 7 One type of suture versus another type of suture, Outcome 3 Urge symptoms or urge incontinence.

Comparison 7 One type of suture versus another type of suture, Outcome 4 Pain score.
Figures and Tables -
Analysis 7.4

Comparison 7 One type of suture versus another type of suture, Outcome 4 Pain score.

Comparison 1. Needle suspension versus open abdominal retropubic suspension

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

5

517

Risk Ratio (M‐H, Fixed, 95% CI)

1.70 [1.11, 2.60]

1.1 Objective/genuine stress incontinence (only)

5

517

Risk Ratio (M‐H, Fixed, 95% CI)

1.70 [1.11, 2.60]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

7

610

Risk Ratio (M‐H, Fixed, 95% CI)

2.00 [1.47, 2.72]

2.1 Objective/genuine stress incontinence (only)

7

610

Risk Ratio (M‐H, Fixed, 95% CI)

2.00 [1.47, 2.72]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number not improved (worse or unchanged) within first year Show forest plot

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.07, 7.73]

3.1 Objective/genuine stress incontinence (only)

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.07, 7.73]

3.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number not improved (worse or unchanged) after first year Show forest plot

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.37, 6.04]

4.1 Objective/genuine stress incontinence (only)

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.37, 6.04]

4.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Urge symptoms or urge incontinence Show forest plot

4

297

Risk Ratio (M‐H, Fixed, 95% CI)

1.80 [0.71, 4.56]

5.1 Objective/genuine stress incontinence (only)

4

297

Risk Ratio (M‐H, Fixed, 95% CI)

1.80 [0.71, 4.56]

5.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Voiding dysfunction after 3 months Show forest plot

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

2.12 [0.81, 5.55]

6.1 Objective/genuine stress incontinence (only)

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

2.12 [0.81, 5.55]

6.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Detrusor overactivity (objective diagnosis by urodynamics) Show forest plot

2

101

Risk Ratio (M‐H, Fixed, 95% CI)

2.91 [0.73, 11.58]

7.1 Objective/genuine stress incontinence (only)

2

101

Risk Ratio (M‐H, Fixed, 95% CI)

2.91 [0.73, 11.58]

7.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 New or persistent prolapse Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

2.24 [0.21, 23.57]

8.1 Objective/genuine stress incontinence (only)

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

2.24 [0.21, 23.57]

8.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9 Peri‐operative surgical complications Show forest plot

3

152

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.83]

9.1 Objective/genuine stress incontinence (only)

3

152

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.83]

9.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

9.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

10 Length of stay/time to return to normal function Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 1. Needle suspension versus open abdominal retropubic suspension
Comparison 2. Needle suspension versus open abdominal retropubic suspension (no previous surgery)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

3

417

Risk Ratio (M‐H, Fixed, 95% CI)

2.05 [1.20, 3.50]

1.1 Objective/genuine stress incontinence (only)

3

417

Risk Ratio (M‐H, Fixed, 95% CI)

2.05 [1.20, 3.50]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

3

408

Risk Ratio (M‐H, Fixed, 95% CI)

2.37 [1.54, 3.66]

2.1 Objective/genuine stress incontinence (only)

3

408

Risk Ratio (M‐H, Fixed, 95% CI)

2.37 [1.54, 3.66]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Urge symptoms or urge incontinence Show forest plot

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

2.49 [0.55, 11.30]

3.1 Objective/genuine stress incontinence (only)

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

2.49 [0.55, 11.30]

3.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 New or persistent prolapse Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

2.24 [0.21, 23.57]

4.1 Objective/genuine stress incontinence (only)

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

2.24 [0.21, 23.57]

4.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Needle suspension versus open abdominal retropubic suspension (no previous surgery)
Comparison 3. Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.55, 2.29]

1.1 Objective/genuine stress incontinence (only)

2

100

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.55, 2.29]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

1.61 [1.04, 2.49]

2.1 Objective/genuine stress incontinence (only)

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

1.61 [1.04, 2.49]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Number not improved (worse or unchanged) within first year Show forest plot

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.07, 7.73]

3.1 Objective/genuine stress incontinence (only)

1

50

Risk Ratio (M‐H, Fixed, 95% CI)

0.75 [0.07, 7.73]

3.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Number not improved (worse or unchanged) after first year Show forest plot

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.37, 6.04]

4.1 Objective/genuine stress incontinence (only)

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.37, 6.04]

4.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Urge symptoms or urge incontinence Show forest plot

3

151

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.42, 4.59]

5.1 Objective/genuine stress incontinence (only)

3

151

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.42, 4.59]

5.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Voiding dysfunction after 3 months Show forest plot

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

2.12 [0.81, 5.55]

6.1 Objective/genuine stress incontinence (only)

4

202

Risk Ratio (M‐H, Fixed, 95% CI)

2.12 [0.81, 5.55]

6.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Detrusor overactivity (objective diagnosis by urodynamics) Show forest plot

2

101

Risk Ratio (M‐H, Fixed, 95% CI)

2.91 [0.73, 11.58]

7.1 Objective/genuine stress incontinence (only)

2

101

Risk Ratio (M‐H, Fixed, 95% CI)

2.91 [0.73, 11.58]

7.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Peri‐operative surgical complications Show forest plot

3

152

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.83]

8.1 Objective/genuine stress incontinence (only)

3

152

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [0.73, 2.83]

8.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 3. Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery)
Comparison 4. Needle suspension versus suburethral sling operations

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

2.0 [0.21, 18.69]

1.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

2.0 [0.21, 18.69]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.37, 24.17]

2.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.37, 24.17]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Urge symptoms or urge incontinence Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.19, 1.86]

3.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.6 [0.19, 1.86]

3.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Voiding dysfunction after 3 months Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.12, 2.14]

4.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.12, 2.14]

4.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Detrusor overactivity (objective diagnosis by urodynamics) Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.05, 4.67]

5.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.05, 4.67]

5.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Peri‐operative surgical complications Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.06, 0.78]

6.1 Objective/genuine stress incontinence (only)

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.22 [0.06, 0.78]

6.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Length of inpatient stay Show forest plot

1

20

Mean Difference (IV, Fixed, 95% CI)

‐13.0 [‐19.00, ‐5.00]

7.1 Objective/genuine stress incontinence (only)

1

20

Mean Difference (IV, Fixed, 95% CI)

‐13.0 [‐19.00, ‐5.00]

7.2 Subjective stress incontinence (only)

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.3 Mixed incontinence

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 4. Needle suspension versus suburethral sling operations
Comparison 5. Needle suspension versus anterior vaginal repair

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

2

266

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.63, 1.46]

1.1 Objective/genuine stress incontinence (only)

2

266

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.63, 1.46]

1.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Mixed incontinence

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

3

337

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.64, 1.16]

2.1 Objective/genuine stress incontinence (only)

2

257

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.68, 1.26]

2.2 Subjective stress incontinence (only)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 Mixed incontinence

1

80

Risk Ratio (M‐H, Fixed, 95% CI)

0.53 [0.19, 1.46]

3 Urge symptoms or urge incontinence Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Objective/genuine stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Subjective stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Mixed incontinence

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Voiding dysfunction after 3 months Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.1 Objective/genuine stress incontinence (only)

2

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.2 Subjective stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4.3 Mixed incontinence

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Peri‐operative surgical complications Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5.1 Objective/genuine stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 Subjective stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 Mixed incontinence

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 New or persistent prolapse Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

6.1 Objective/genuine stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.2 Subjective stress incontinence (only)

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 Mixed incontinence

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 5. Needle suspension versus anterior vaginal repair
Comparison 6. One type of needle suspension versus another type of needle suspension

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

2.87 [0.31, 26.56]

1.1 Raz versus transvaginal Burch (Gilja)

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

2.87 [0.31, 26.56]

2 Number not cured (worse, unchanged or improved) after first year Show forest plot

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [0.53, 5.32]

2.1 Raz versus transvaginal Burch (Gilja)

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [0.53, 5.32]

3 Urge symptoms or urge incontinence Show forest plot

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.59 [0.40, 6.28]

3.1 Raz versus transvaginal Burch (Gilja)

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

1.59 [0.40, 6.28]

Figures and Tables -
Comparison 6. One type of needle suspension versus another type of needle suspension
Comparison 7. One type of suture versus another type of suture

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Number not cured (worse, unchanged or improved) within first year Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.17 [0.01, 2.94]

2 Number not improved (worse or unchanged) within first year Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.4 [0.02, 8.78]

3 Urge symptoms or urge incontinence Show forest plot

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

0.24 [0.01, 4.44]

4 Pain score Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 At one month

1

19

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.87, 0.67]

4.2 At three months

1

20

Mean Difference (IV, Fixed, 95% CI)

‐0.92 [‐1.77, ‐0.07]

Figures and Tables -
Comparison 7. One type of suture versus another type of suture