Effectiveness and Safety of Tension-free Vaginal Tapes versus Burch Colposuspension for Female Stress Urinary Incontinence: A Systematic Review and Meta-analyses of Randomized Controlled Trials_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Minggen ,  ZHAO Xiaokun , WU Zhiping , XIAO Ning , LV Chen , HOU Yi

Department of Urology, Second Xiangya Hospital, Central South University, Changsha 410011, China;

Corresponding author：

ZHAO Xiaokun, Email: zhaoxiaokun50@163.com

Keywords：

Stress urinary incontinence; Tension-free vaginal tape; Burch colposuspension; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20080053

Video：

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Objective　 To evaluate the effectiveness and safety of tension-free vaginal tapes (TVT) compared with Burch colposuspension for female stress urinary incontinence (SUI).
Methods　 We searched MEDLINE (1966 to October 2007), EMBASE (1988 to October 2007), Cochrane Central Register of Controlled Trials (1993 to October 2007), CMCC (1979 to October 2007) and CNKI (January 1979 to October 2007). We collected randomized controlled trials (RCTs) comparing TVT with Burch colposuspension in the treatment of SUI. Data were extracted and evaluated by two reviewers independently. The Cochrane Collaboration’s RevMan 4.2 was used for data analyses.
Results　 Ten RCTs reporting data on effectiveness and safety of TVE versus Burch colposuspension were included. Meta-analyses showed that TVT was superior to Burch colposuspension as measured by the overall cure rate (OR 1.73; 95%CI 1.26 to 2.38; P=0.0007), negative stress test (OR 2.54; 95%CI 1.71 to 3.78; P lt;0.00001) and negative pad test (OR 1.67; 95%CI 1.16 to 2.41; P=0.006). The total complication rate was higher after TVT (OR 1.39; 95% CI 1.08 to 1.80; P=0.01), while the re-operation rate was significantly higher after Burch colposuspension (OR 0.29; 95%CI 0.10 to 0.80; P=0.02). The incidences of haematoma (OR 1.06; 95% CI 0.39 to 2.84; P=0.91), urinary tract infection (OR 1.27; 95% CI 0.64 to 2.52; P=0.50) and lower urinary tract symptoms (OR 1.20; 95% CI 0.89 to 1.62; P=0.23) were similar after TVT and Burch colposuspension.
Conclusion　 The evidence for short-term superiority of TVT is currently limited. Although the re-operation rate is lower, the risk of bladder or vaginal injury is higher with TVT. Methodologically sound and adequately powered RCTs with long-term follow-up are needed.

Citation： YANG Minggen,ZHAO Xiaokun,WU Zhiping,XIAO Ning,LV Chen,HOU Yi. Effectiveness and Safety of Tension-free Vaginal Tapes versus Burch Colposuspension for Female Stress Urinary Incontinence: A Systematic Review and Meta-analyses of Randomized Controlled Trials. Chinese Journal of Evidence-Based Medicine, 2008, 08(4): 237-243. doi: 10.7507/1672-2531.20080053 Copy

1.	川罗新, 朱亚飞. 女性压力性尿失禁的手术治疗和评价. 实用妇产科杂志, 2003, 21(2): 12-15.
2.	Tension-free vaginal tape (TVT) procedure. Tension-free vaginal tape (TVT) procedure. Int J Gynaecol Obstet, 2005, 91(3): 279-282.
3.	Novara G, Ficarra V, Boscolo-Berto R, et al. Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness. Eur Urol, 2007, 52(3): 663-678.
4.	Debodinance P, Delporte P, Engrand JB, et al. tension-free vaginal tape (TVT) in the treatment of urinary stress incontinence: 3 years experience involving 256 operations. Euro J Obstet Gynaecol, 2002, 105(1): 49-58.
5.	Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1, 2000, Oxford, Update Software.
6.	Liapis A, Bakas P, Creatsas G. Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women. Eur Urol, 2002, 41(4): 469-473.
7.	Persson J, Teleman P, Eten-Bergquist C, et al. Cost-analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure. Acta Obstet Gynecol Scand, 2002, 81(11): 1066-1073.
8.	Ward K, Hilton P, United Kingdom, et al. Prospective multicentre randomized trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ, 2002, 325(7355): 67.
9.	Ustun Y, Engin-Ustun Y, Gungor M, et al. Tension free vaginal tape compared with laparoscopic Burch urethropexy. J Am Assoc Gynecol Laparosc, 2003, 10(3): 386-389.
10.	Valpas A, Kivelä A, Penttinen J, et al. Tension-free vaginal tape and laparoscopic complications-A randomized clinical trail. Acta Obstet Gynecol Scand, 2003, 82(7): 665-671.
11.	Paraiso MF, Walters MD, Karram MM, et al. Laparoscopic Burch colposuspension versus tension-free vaginal tape: a randomized trial. Obstet Gynecol, 2004, 104(6): 1249-1258.
12.	Valpas A, Kivela A, Penttinen J, et al. Tension-free vaginal tape and laparoscopic mesh colposuspension for stress urinary incontinence. Obstet Gynecol, 2004, 104(1): 42-49.
13.	Ward KL, Hilton P, UK, et al. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol, 2004, 190(2): 324-331.
14.	Bai SW, Sohn WH, Chung DJ, et al. Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence. Int J Gynaecol Obstet, 2005, 91(3): 246-251.
15.	El-Barky E, El-Shazly A, El-Wahab OA, et al. Tension free vaginal tape versus Burch colposuspension for treatment of female stress urinary incontinence. Int Urol Nephrol, 2005, 37(2): 277-281.
16.	Fiori M, Gunelli R, Mercuriali M, Bercovich E. Tension-free vaginal tape and female stress incontinence: further evidence of effectiveness. Urologia Intemationalis, 2004, 72(4): 325-328.
17.	罗新. 女性压力性尿失禁的诊断方法和评价(之二). 中国实用妇科与产科杂志, 2006, 22(10): 798-799.
18.	Devereaux PJ, Bhandari M, Clark M, et al. Need for expertise based randomized controlled trials. BMJ, 2005, 330(7488): 88.

1. 川罗新, 朱亚飞. 女性压力性尿失禁的手术治疗和评价. 实用妇产科杂志, 2003, 21(2): 12-15.
2. Tension-free vaginal tape (TVT) procedure. Tension-free vaginal tape (TVT) procedure. Int J Gynaecol Obstet, 2005, 91(3): 279-282.
3. Novara G, Ficarra V, Boscolo-Berto R, et al. Tension-free midurethral slings in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of randomized controlled trials of effectiveness. Eur Urol, 2007, 52(3): 663-678.
4. Debodinance P, Delporte P, Engrand JB, et al. tension-free vaginal tape (TVT) in the treatment of urinary stress incontinence: 3 years experience involving 256 operations. Euro J Obstet Gynaecol, 2002, 105(1): 49-58.
5. Mulrow CD, Oxman AD. The Cochrane Collaboration handbook, Issue 1, 2000, Oxford, Update Software.
6. Liapis A, Bakas P, Creatsas G. Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women. Eur Urol, 2002, 41(4): 469-473.
7. Persson J, Teleman P, Eten-Bergquist C, et al. Cost-analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure. Acta Obstet Gynecol Scand, 2002, 81(11): 1066-1073.
8. Ward K, Hilton P, United Kingdom, et al. Prospective multicentre randomized trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ, 2002, 325(7355): 67.
9. Ustun Y, Engin-Ustun Y, Gungor M, et al. Tension free vaginal tape compared with laparoscopic Burch urethropexy. J Am Assoc Gynecol Laparosc, 2003, 10(3): 386-389.
10. Valpas A, Kivelä A, Penttinen J, et al. Tension-free vaginal tape and laparoscopic complications-A randomized clinical trail. Acta Obstet Gynecol Scand, 2003, 82(7): 665-671.
11. Paraiso MF, Walters MD, Karram MM, et al. Laparoscopic Burch colposuspension versus tension-free vaginal tape: a randomized trial. Obstet Gynecol, 2004, 104(6): 1249-1258.
12. Valpas A, Kivela A, Penttinen J, et al. Tension-free vaginal tape and laparoscopic mesh colposuspension for stress urinary incontinence. Obstet Gynecol, 2004, 104(1): 42-49.
13. Ward KL, Hilton P, UK, et al. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol, 2004, 190(2): 324-331.
14. Bai SW, Sohn WH, Chung DJ, et al. Comparison of the efficacy of Burch colposuspension, pubovaginal sling, and tension-free vaginal tape for stress urinary incontinence. Int J Gynaecol Obstet, 2005, 91(3): 246-251.
15. El-Barky E, El-Shazly A, El-Wahab OA, et al. Tension free vaginal tape versus Burch colposuspension for treatment of female stress urinary incontinence. Int Urol Nephrol, 2005, 37(2): 277-281.
16. Fiori M, Gunelli R, Mercuriali M, Bercovich E. Tension-free vaginal tape and female stress incontinence: further evidence of effectiveness. Urologia Intemationalis, 2004, 72(4): 325-328.
17. 罗新. 女性压力性尿失禁的诊断方法和评价(之二). 中国实用妇科与产科杂志, 2006, 22(10): 798-799.
18. Devereaux PJ, Bhandari M, Clark M, et al. Need for expertise based randomized controlled trials. BMJ, 2005, 330(7488): 88.

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Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Tension-free Vaginal Tapes versus Burch Colposuspension for Female Stress Urinary Incontinence: A Systematic Review and Meta-analyses of Randomized Controlled Trials

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