Minimally invasive operations are just as effective in treating stress urinary incontinence in women as traditional open surgical approaches, Cochrane researchers have indicated.
They came to this conclusion after conducting a systematic review of trials comparing different surgical approaches to treating the condition.
AdvertisementIn sling operations, strips of material are positioned under the urethra and traditionally are anchored to muscles and ligaments to form a sling. The sling tightens and supports the bladder when the woman strains.
In newer minimally invasive sling operations, a synthetic material is inserted underneath the urethra without fixing to muscles or ligaments.
The researchers say that in the minimally invasive sub-urethral sling operation, which can be carried out under local anaesthetic, the synthetic sling material can be inserted with a needle.
For the review, they collected data from 62 trials involving 7,101 women.
The experts say that minimally invasive synthetic suburethral sling operations were found to be just as effective as traditional sling operations, with short-term cure rates of 80 per cent.
Such operations also had shorter operating times than conventional methods, they add.
According to them, minimally invasive sling operations were also more effective than a second type of open surgery, in which the vagina is lifted using stitches to help support the bladder and urethra.
However, when the second type of surgery was carried out using keyhole cuts, there was less evidence that minimally invasive sling operations worked better.
The researchers also compared different ways of inserting the tape in sling operations, and said that those in which the tape was passed behind the pubic bone appeared to be most effective, although this approach was more likely to cause bladder injury.
One particular type of material, called type I mesh, was more effective and appeared to result in fewer complications.
"These were only small trials and they varied greatly in quality, but we were able to make comparisons between different types of surgery and we found that minimally invasive sling operations for stress incontinence in women are very effective for this condition," says lead researcher Joseph Ogah, based at the Leeds University Teaching Hospital in Leeds, in the UK.
"However, few of the trials we looked at reported outcomes after one year and therefore the long term efficacy of these procedures requires further investigation. It is also of utmost importance to assess how these procedures impact on women's quality of life, so this needs to be addressed in further studies," says Ogah.
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