Outcomes of concomitant midurethral sling and anterior colporrhaphy in managing stress urinary incontinence associated with cystocele: a systematic review and single-arm analysis

Abstract

BACKGROUND: Multiple surgical approaches have been provided for treating Stress urinary incontinence (SUI) combined with anterior vaginal wall prolapse (cystocele). However the optimal treatment remains a topic of ongoing debate. This systematic review and single-arm analysis aimed to evaluate the efficacy and safety of midurethral sling (MUS) with concomitant anterior colporrhaphy (AC) for surgical treatment of stress urinary incontinence associated with grade 1-3 anterior vaginal wall prolapse. METHODS: We searched through multiple databases including, PubMed, Cochrane, Scopus, and Web of Science using a well-established search strategy to identify studies assessing the outcomes of MUS with concomitant AC in women with SUI and grade 1-3 cystocele. Data was extracted from the relevant studies in a predefined excel sheet. Data analysis was accomplished by using OpenMeta [analyst] software. RESULTS: We found 744 articles and included eight studies in the analysis. The pooled objective cure rate of SUI was 0.907 (95% CI 0.871 to 0.943), objective failure of SUI was 0.036 (95% CI 0.002 to 0.071), the subjective cure rate was 0.825 (95% CI 0.717 to 0.932), and the anatomical success rate for cystocele was 0.919 (95% CI 0.851 to 0.987). De novo urge urinary incontinence was reported in 12 of 81 patients, and four of 46 patients developed de novo OAB symptoms. Postoperative retention was noted in 5% of 405 patients. Long-term follow-up data from two studies indicated a durable effect. CONCLUSION: MUS combined with AC is an effective option for treating SUI associated with grade 1-3 cystocele, with high rates of both objective and subjective cure.