关键词: 压力性尿失禁, 网状Meta分析, 外科治疗, 治疗结果, 手术后并发症

Abstract: Background　Female stress urinary incontinence（SUI） is a common urological disease that causes enormous life and financial burden on female patients.SUI patients usually choose surgical treatment when conservative treatment is not ideal.Since Kelly has been used to treat SUI，a variety of new surgical procedures has achieved significant progress in clinical practice.There is still lack of direct or indirect comparison in terms with medium and long-term efficacy and safety between new surgical procedures.Objective　To compare the efficacy and safety of Burch，tension-free vaginal tape（TVT），outside-in transobturator tape（TOT），inside-out tension-free vaginal tape-obturator（TVT-O），tension-free vaginal tape -sling（TVT-S） and adjustable anchored single-incision mini-slings（Ajust） in the treatment of SUI by using network meta-analysis，and screen out the most optimal surgical approach for SUI.Methods　All studies of randomized controlled trials（RCTs） were searched in the PubMed，the Cochrane Library，Medline，EMBase database to compare the efficacy and safety of Burch，TVT，TOT，TVT-O，TVT-S and Ajust from database building to July 2018.Two researchers evaluated the quality of the included RCT and extracted the data，including the first author，publication time，intervention measures，sample size，age，follow-up time and objective cure rate，subjective cure rate，dysuria，vaginal mucosal perforation，lower urinary tract infection，sling exposure，new emergent symptoms after operation/urgent urinary incontinence，thigh pain/inguinal pain after operation.We used RevMan 5.3 software and Stata 14.0 to analyse the data involved.Results　A total of 42 RCTs and 6，065 patients were included.The network meta-analysis showed that the objective cure rate of TOT was lower than that of TVT 〔OR=0.96，95%CI（0.91，1.00），P<0.05〕.Subjective cure rate of Ajust was higher than Burch，TOT，TVT-O，TVT-S〔OR=1.27，95%CI（1.01，1.61）；OR=1.14，95%CI（1.01，1.27）；OR=1.05，95%CI（1.00，1.10）；OR=1.12，95%CI（1.04，1.22），P<0.05〕，and subjective cure rate of TOT was lower than that of TVT 〔OR=0.93，95%CI（0.86，1.00），P<0.05〕.Dysuria incidence of TVT-O was lower than that of TVT 〔OR=0.57，95%CI（ 0.34，0.95），P<0.05〕.The incidence of vaginal epithelial perforation in TOT was higher than that in TVT 〔OR=4.17，95%CI（1.37，12.74），P<0.05〕，and incidence of vaginal epithelial perforation in TVT-O was lower than that in TOT 〔OR=0.20，95 %CI（0.06，0.66），P<0.05〕.The incidence of urinary tract infection in TOT was lower than that in TVT〔OR=0.62，95%CI（0.42，0.91），P<0.05〕.The incidence of groin or thigh pain in TVT-O was higher than that in Burch 〔OR=12.89，95%CI（1.22，135.66），P<0.05〕；incidence of groin or thigh pain in TOT and TVT-O was higher than that in TVT 〔OR=2.37，95%CI（1.00，5.58）；OR=3.07，95%CI（1.50，6.27），P<0.05〕；incidence of groin or thigh pain in TVT-S and Ajust was lower than that in TVT-O 〔OR=0.25，95%CI（0.10，0.63）；OR=0.18，95%CI（0.04，0.84），P<0.05〕.The surface under the cumulative ranking curves（SUCRA） value ranking results showed that TVT had better objective cure rate，sling exposure and fewer new emergent symptoms/urgent urinary incontinence after operation；Ajust had significantly better subjective cure rate，fewer dysuria and vaginal perforation；TOT had a better superiority in urinary tract infection；Burch had a better superiority in groin or thigh pain.Conclusion　Ajust is probably associated with better efficacy and safety in the medium and long term study of SUI treatment.

Key words: Stress urinary incontinence, Network meta-analysis, Surgical treatment, Treatment outcome, Postoperative complications