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Voies d'abord et complications des bandelettes sous-urétrales synthétiques chez la femme : Revue systématique de la littérature et méta-analyse

par Biardeau, Xavier;Zanaty, Marc;Aoun, Fouad ;Benbouzid, Sabrina;Peyronnet, Benoit
Référence Progrès en urologie, 26, 4, page (254-269)
Publication Publié, 2016-03

Article révisé par les pairs

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Résumé :

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.