Colocación de segunda cinta de uretra media en el manejo de incontinencia urinaria recurrente o persistente en contraste con otras opciones terapéuticas. Revisión sistemática de la literatura y meta-análisis

Abstract

Introduction: Female urinary incontinence has a prevalence of up to 40%. First-line surgical management is with mid urethral tapes in the case of stress-type incontinence, however, when such management fails, it is unclear what should be the management . Methodology: Systematic review of the literature with meta-analysis of proportions, including observational and interventional studies, in which the management of recurrent or persistent urinary incontinence in women with a mid urethral tape was evaluated. Results: 161 studies were identified and screened in the systematic search, 29 studies were included in the qualitative synthesis and 27 in the quantitative synthesis. Given the high clinical and methodological heterogeneity between the studies, a measure of cure and / or combination / cure / improvement ratio was obtained for each type of management and no comparison was made between them. A combined total cure rate on adjustable tapes was estimated at 86% (95% CI: 76. 4% -92. 1%), the second mid urethral tape at 75. 1% (95% CI: 68% -81. 1 %), the shortenning of the previous tape at 62. 3% (95% CI: 49. 1% -73. 9%) and in the implantation of bulking agents at 55. 4% (95% CI: 43. 2 % -67%). We were not able to perform such analysis with respect to: pubovaginal sling, colposuspension and pelvic floor therapy, as well as secondary outcomes. Conclusion: The evidence found does not allow us to generate a degree of recommendation. It is important to note that these results should be corroborated with multicenter, randomized, collaborative trials