Stress urinary incontinence and synthetic mesh midurethral slings in women

Rowan Hutchins — Wed, 27 Sep 2023 05:00:00 +0000

Date Added:

September 27, 2023

Journal/Publication:

CMAJ

Publisher:

CMA

Publication Date:

August 21, 2023

Issue:

Volume:

195

URL:

Stress urinary incontinence and synthetic mesh midurethral slings in women

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.221592

Keywords

female

Surgical treatment

suburethral slings

PMID (1):

37604526

MeSH

urinary incontinence

Stress* / surgery

Surgical Mesh / adverse effects

Suburethral Slings* / adverse effects

A concise review of the management of stress urinary incontinence in women including the use of synthetic mesh. James W. Mold, MD, MPH

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Stress urinary incontinence has a prevalence of 10%–40% and is considered severe in 3%–17% of women worldwide.1 Diagnosis involves demonstrating involuntary urine leakage with increases in intra-abdominal pressure (e.g., exercising, coughing). On history, it is important to differentiate this leakage from symptoms like urgency, frequency and nocturia, as these may indicate mixed urinary incontinence or overactive bladder.

Author/s:

Kanji, Sarah, Clancy, Aisling A.

Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis

Devin Evans — Wed, 03 Feb 2021 06:00:00 +0000

Date Added:

February 3, 2021

Journal/Publication:

BMC Musculoskeletal Disorders

Publication Date:

January 8, 2021

Issue:

Volume:

Pages:

URL:

Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s12891-020-03872-4

Keywords

Conservative treatment

PMID (1):

33419401

MeSH

conservative treatment

Shoulder

MEDLINE

pain

This meta-analysis found very little benefit from rotator cuff surgery in patients with full thickness tears compared to conservative management. James W. Mold, MD, MPH

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Background: This study aims to compare conservative versus surgical management for patients with full-thickness RC tear in terms of clinical and structural outcomes at 1 and 2 years of follow-up.

Methods: A comprehensive search of CENTRAL, MEDLINE, EMBASE, CINAHL, Google Scholar and reference lists of retrieved articles was performed since the inception of each database until August 2020. According to the Cochrane Handbook for Systematic Reviews of Interventions, two independent authors screened all suitable studies for the inclusion, extracted data and assessed risk of bias. Only randomised controlled trials comparing conservative and surgical management of full-thickness RC tear in adults were included. The primary outcome measure was the effectiveness of each treatment in terms of Constant-Murley score (CMS) and VAS pain score at different time points. The secondary outcome was the integrity of the repaired tendon evaluated on postoperative MRI at different time points. The GRADE guidelines were used to assess the critical appraisal status and quality of evidence.

Results: A total of six articles met the inclusion criteria. The average value of CMS score at 12 months of follow-up was 77.6 ± 14.4 in the surgery group and 72.8 ± 16.5 in the conservative group, without statistically significant differences between the groups. Similar results were demonstrated at 24 months of follow-up. The mean of VAS pain score at 12 months of follow-up was 1.4 ± 1.6 in the surgery group and 2.4 ± 1.9 in the conservative group. Quantitative synthesis showed better results in favour of the surgical group in terms of VAS pain score one year after surgery (- 1.08, 95% CI - 1.58 to - 0.58; P < 0.001).

Conclusions: At a 2-year follow-up, shoulder function evaluated in terms of CMS was not significantly improved. Further high-quality level-I randomised controlled trials at longer term follow-up are needed to evaluate whether surgical and conservative treatment provide comparable long-term results.

Author/s:

Longo, Umile G., Ambrogioni, Laura R., Candela, Vincenzo, Berton, Alessandra, Carnevale, Arianna, Schena, Emiliano, Denaro, Vincenzo