Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. May 10, 2016; 5(2): 197-209
Published online May 10, 2016. doi: 10.5317/wjog.v5.i2.197
Single incision slings: Are they ready for real life?
Manuela Tutolo, Dirk De Ridder, Frank Van der Aa
Manuela Tutolo, 2nd Urological Department, San Raffaele Hospital, University Vita-Salute, 20132 Milan, Italy
Manuela Tutolo, Dirk De Ridder, Frank Van der Aa, Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: Dirk De Ridder has received fees for serving as a consultant and/or advisory board member for AMS; Frank Van der Aa has received fees for serving as a consultant and/or advisory board member for AMS.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Dryad repository, who will provide a permanent, citable and open-access home for the dataset.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Manuela Tutolo, MD, Deparment of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Telephone: +32-16-346930 Fax: +32-16-346931
Received: September 3, 2015
Peer-review started: September 18, 2015
First decision: October 30, 2015
Revised: December 8, 2015
Accepted: January 21, 2016
Article in press: January 22, 2016
Published online: May 10, 2016

AIM: To review of the efficacy and safety outcomes of different single incision slings (SIS) systems, also in comparison with traditional slings.

METHODS: A literature search was conducted in PubMed/MEDLINE database. The research was restricted to randomized and/or prospective trials and retrospective studies, published after 2006, with at least 20 patients with non-neurogenic stress urinary incontinence (SUI). The studies had to assess efficacy and/or safety of the SIS with a minimum follow-up of 12 mo. All the paper assessing the performance of tension free vaginal tape secur were excluded from this review. The final selection included 19 papers fulfilling the aforementioned criteria. Two authors independently reviewed the selected papers.

RESULTS: Four different SIS systems were analysed: Ajust®, Ophira®, Altis® and MiniArc®. The average objective cure rate was 88%. Overall no statistically significant differences were found between SIS and traditional mid-urethral slings (MUS) in terms of objective cure (all P > 0.005). Only one paper showed a statistically lower success rate in MiniArc®vs Advantage® slings (40% vs 90%) and higher rates of failure in the SIS group. Since there was a great variability in terms of tests performed, it was not possible to compare subjective cure between studies. The vast part of the studies showed no major complications after SIS surgery. We also observed very low reported pain rates in SIS patients. The RCTs on Ajust® and MiniArc®, showed better outcomes in terms of post-operative pain compared to MUS. None of the patients reported long- term pain complains.

CONCLUSION: SIS showed similar efficacy to that of traditional slings but lower short-term pain, complication and failure rates.

Keywords: Female urological diseases, Urinary stress incontinence, Pelvic floor disorders, Minimally invasive surgery, Mid-urethral slings

Core tip: This review shows an average objective cure rate of 88% in minisling patients and underlines their comparable efficacy with traditional slings. Short term pain, complication and failure rates are lower in the minisling group.