BACKGROUND AND PURPOSE:

• In this update, Freites et al. (Cochrane Reviews, 2019) assessed the effectiveness of laparoscopic colposuspension for urinary incontinence in women vs other methods

METHODS:

• Systematic review and meta-analysis
• Data sources
  • Cochrane Incontinence Specialized Register (22 May 2019): Contains trials from databases such as MEDLINE, ClinicalTrials.gov and WHO ICTRP
  • Authors also handsearched journals and conference proceedings
• Inclusion criteria
  • RCTs of women with urinary incontinence that included laparoscopic surgery in at least one arm
• Study design and data analysis
  • The authors independently extracted data from eligible trials, assessed risk of bias | Used GRADE criteria

RESULTS:

• 26 trials | Total of 2,271 women
  • Follow-up: Most trials only up to 18 months

Laparoscopic Colposuspension vs Open Colposuspension

• Overall, 13 trials | 1,304 women
• Sutures: No significant difference between two groups for subjective cure within 18 months
  • Risk ratio (RR) 1.04 (95% CI, 0.99 to 1.08; high-quality evidence)
• Mesh and staples: Uncertain if laparoscopic colposuspension is better or worse for subjective cure within 18 months
  • RR 0.75 (95% CI, 0.61 to 0.93; very low-quality evidence)
• Laparoscopic colposuspension may have a lower risk of perioperative complications
  • RR 0.67 (95% CI 0.47 to 0.94; low-quality evidence)
• There may be the same or higher rates of bladder perforations with laparoscopic colposuspension
  • RR 1.72 (95% CI 0.90 to 3.29; moderate-quality evidence)
• Rates for de novo detrusor overactivity and voiding dysfunction appear to be similar between the 2 approaches
• Uncertain whether greater risk of repeat continence surgery with laparoscopic colposuspension
• Authors could not synthesize quality of life data

Laparoscopic Colposuspension vs Tension-Free Vaginal Tape (TVT)

• Overall 9 trials | 412 women
• Sutures: No significant difference between two groups for subjective cure within 18 months
  • RR 1.01 (95% CI, 0.88 to 1.16; low-quality evidence)
• Mesh and staples: No significant difference between the two groups for subjective cure within 18 months
  • RR 0.71 (95% CI, 0.55 to 0.91; low-quality evidence)

Laparoscopic Colposuspension vs Midurethral Slings

• Uncertain if laparoscopic colposuspension is beneficial for the following due to wide confidence intervals
  • Lower rates of repeat continence surgery: RR 0.40 (95% CI 0.04 to 3.62; low-quality evidence)
  • Perioperative complications: RR 0.99, 95% CI 0.60 to 1.64; low-quality evidence)
• Uncertain if there is any benefit for de novo detrusor overactivity or voiding dysfunction, though this remains uncertain due to the wide confidence interval
• Authors could not synthesize quality of life data
• No studies reported on bladder perforations

Laparoscopic Colposuspension with Two Sutures vs One Suture

• Overall 1 trial | 161 women
• There may be higher subjective cure rates within 18 months with two sutures compared to one suture
  • RR 1.37 (95% CI, 1.14 to 1.64; low-quality evidence)
• Uncertain whether one suture vs two sutures
  • May have lower rates of repeat continence surgery
  • May have similar risk of perioperative complications
  • May have higher rates of voiding dysfunction
• Bladder perforations, de novo detrusor overactivity or quality of life not reported

Laparoscopic Colposuspension with Sutures Vs Mesh And Staples

• Overall 3 trials | 261 women
• Uncertain whether laparoscopic colposuspension with sutures
  • May be better or worse for subjective cure within 18 months
  • May be better or worse for repeat continence surgery
• Laparoscopic colposuspension with sutures may increase the number of perioperative complications vs mesh and staples
  • RR 1.94 (95% CI 1.09 to 3.48; low-quality evidence)
• Bladder perforations, voiding dysfunction or quality of life not reported

CONCLUSION:

• When judging by subjective cure of incontinence within 18 months
  • Laparoscopic colposuspension appears to be as effective as open colposuspension or midurethral sling procedures
• Authors caution that evidence was generally low-quality and therefore limits ability to draw conclusions
• Uncertain results likewise do not mean an absence of benefit but rather that more high-quality, long term studies are needed in the field

Learn More – Primary Sources:

Laparoscopic colposuspension for urinary incontinence in women

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