Synthetic versus nonsynthetic slings for female stress and mixed urinary incontinence

The goal of a study was to systematically review the objective and subjective success rates and surgical outcomes of suburethral sling surgeries for females with stress or mixed urinary incontinence and compare the use of synthetic materials with nonsynthetic ones (autologous, allograft, or xenograft) in different surgical approaches (retropubic or transobturator).

This systematic review and meta-analysis searched several databases – Medline, Embase, EBM Reviews, ClinicalTrials.gov, and Web of Science Core Collection, without date restrictions using standardized Medical Subject Headings (MeSH). 

Eligible studies were peer-reviewed randomized controlled trials (RCTs) and comparative studies (prospective or retrospective) on retropubic or transobturator slings using synthetic or nonsynthetic materials for female stress or mixed urinary incontinence. Studies needed to have a minimum of 6 weeks of postoperative follow-up. Study quality was assessed using the Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa scale for observational studies. 

Overall, 35 articles (30 studies) were included. The results depicted no difference in continence rates between retropubic synthetic and nonsynthetic slings. However, synthetic slings had fewer reoperations and higher subjective continence rates in patients with ≥25% recurrent stress urinary incontinence. Transobturator slings showed no significant differences between materials, though subjective satisfaction was higher with synthetic slings.

It was concluded that synthetic and nonsynthetic slings provide similar success rates, but synthetic slings tend to result in better surgical outcomes and fewer complications. 

Source: Larouche M, Zheng MM, Yang EC, et al. American Journal of Obstetrics and Gynecology. 2024 Mar 1.