ABSTRACT
Objective To systematically review the efficacy and safety of prolapse surgery versus combined prolapse and midurethral sling surgery in women with pelvic organ prolapse and stress urinary incontinence.Methods Databases including PubMed,EMbase,the Cochrane Library(Issue 7,2016),Web of Knowledge,CNKI,CBM,WanFang Data and VIP were searched from inception to July 31th 2016,to collect randomized controlled trial(RCT) of combined prolapse and midurethral sling surgery versus prolapse surgery for pelvic organ prolapse and stress urinary incontinence.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then,meta-analysis was performed using RevMan 5.3 software.Results A total of 4 RCT involving 446 patients were included.The results of meta-analysis showed that,for postoperative outcomes,compared with prolapse surgery,the incidence of urinary incontinence,stress urinary incontinence,urgency urinary incontinence,any treatment for SUI,surgery for stress urinary incontinence[RR=0.57,95%CI(0.46~0.70),P<0.000;RR=0.24,95%CI(0.10~0.60),P=0.002;RR=0.58,95%CI(0.39~0.85,P=0.006;RR=0.20,95%CI(0.06~0.67),P=0.009;RR=0.07,95%CI(0.01~0.56),P=0.010]were lower in combined prolapse and midurethral sling surgery.For complications,the incidence of bladder perforation or injury,urinary tract infection,incomplete bladder emptying at 1 week[RR=9.72,95%CI(1.78~53.01),P=0.009;RR=1.77,95%CI(1.23~2.54),P=0.002;RR=1.39,95%CI(1.06~1.81),P=0.020]were higher in combined prolapse and midurethral sling surgery,while there were no statistical differences between the two groups in the incidence of voiding dysfunction,vaginal tape erosion,major bleeding or vascular complication.Conclusion For women with pelvic organ prolapse and stress urinary incontinence,compared to prolapse surgery,the incidence of urinary incontinence and treatment of urinary incontinence is lower in combined prolapse and midurethral sling surgery,the incidence of partial complications is higher in combined prolapse and midurethral sling surgery.Due to the limited quality and quantity of the included studies,more high quality studies are needed to verify the above conclusion.