Systematic review and meta-analysis of the efficacy of tension-free vaginal tape on pelvic organ prolapse complicated by stress urinary incontinence.

Abstract

Patients with pelvic organ prolapse combined with stress urinary incontinence (SUI) require pelvic floor repair and surgical treatment; however, there is currently no systematic evaluation of the treatment effect. PubMed, Medline, Embase, Elsevier, The Cochrane Library, Web of science, and other databases were searched for randomized controlled trials (RCTs) published between January 2000 and December 2020 regarding tension-free vaginal tape (TVT) treatment of pelvic organ prolapse combined with SUI. Quality evaluation of the articles included in this study was conducted in accordance with the Cochrane Work Manual (5.3), and RevMan 5.3 software was used to conduct meta-analysis of the data extracted from literature meeting the requirements. A total of 10 articles were included, involving a total of 1,361 subjects, including 553 in the control group (a different surgical treatment) and 808 in the observation group (single TVT or TVT combined with pelvic floor repair). The bias evaluation results showed that all of the included literature was rated as level B, so there was no need for sensitivity analysis. The meta-analysis showed that the combined effect size of the clinical cure rate was {odds ratio (OR) [95% confidence interval (CI)]: 3.82 (1.39, 10.52); Z=2.59, P=0.010}, and the combined effect size of the clinical complication rate was [risk difference (RD) (95% CI): -0.09 (-0.16, -0.02); Z=2.38; P=0.02]. The results showed that the clinical cure rate of the observation group was significantly higher than that of the control group, while the clinical complication rate was significantly lower than that of the control group (P<0.05). TVT surgery or TVT combined with pelvic floor repair surgery can significantly improve the cure rate of patients with pelvic organ prolapse combined with SUI, and reduce the incidence of postoperative complications. Therefore, TVT is a suitable surgical method for the treatment of patients with pelvic organ prolapse combined with SUI.