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Updated: Oct 2, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
[Approach and complications associated with suburethral synthetic slings in women: Systematic review and
X Biardeau1, M Zanaty2, F Aoun3
1Service d'urologie, hôpital Claude-Huriez, CHU de Lille, université Lille-Nord-de-France, 1, rue Polonovski, 59000 Lille, France.
Introduction:
We aim to assess the complications associated with different approaches used in female suburethral sling surgery.
Method:
We performed a research on Medline using the following keywords: "suburethral slings", "complications", "safety" and "randomized". Only randomized clinical trials including women and reporting intra- and postoperative complications associated with the retropubic (RP) approach; TOT and/or TVT-O were included. The meta-analysis was conducted using the Review Manager (RevMan 5.3) software delivered by the "Cochrane Library".
Results:
Out of 176 articles, 23 were included in synthesis. Risks of bladder perforation during surgery (60/1482 vs 5/1479; OR=6.44; 95% CI [3.32-12.50]) and postoperative urinary retention (48/1160 vs 24/1159; OR=1.93; 95% CI [1.26-3.12]) were significantly higher with the RP approach, when compared with the transobturator (TO) approach (TOT or TVT-O). Conversely, the risk of prolonged postoperative pain was significantly lower after RP approach, when compared with TO approach (24/1156 vs 69/1149; OR=0.36; 95% CI [0.23-0.56]). Risks of intraoperative urethral injury, postoperative erosion and de novo overactive bladder were comparable between the two approaches. Data regarding the comparison between TOT and TVT-O were scarce and did not allow us to conclude about complications associated with.
Conclusion:
The RP approach was associated with a significant risk of bladder perforation and postoperative urinary retention. The TO approach was associated with a higher risk of prolonged postoperative pain.
