Review – Incontinence Tension-Free Midurethral Slings in the Treatment of Female Stress Urinary Incontinence: A Systematic Review and Meta-analysis of Randomized Controlled Trials of Effectiveness Giacomo Novara a,b , Vincenzo Ficarra a , Rafael Boscolo-Berto a , Silvia Secco a , Stefano Cavalleri a , Walter Artibani a, * a Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy b I.R.C.C.S. Istituto Oncologico Veneto (IOV), Padua, Italy european urology 52 (2007) 663–679 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted June 11, 2007 Published online ahead of print on June 21, 2007 Keywords: Burch colposuspension Monarc Pubovaginal sling SPARC Stress urinary incontinence Tension-free vaginal tape TOT Trans-obturator tape TVT TVT-O Abstract Objectives: To evaluate the efficacy of tension-free vaginal tape (TVT) compared with other surgical treatments for stress urinary incontinence (SUI) and with other tension-free midurethral slings. Methods: A systematic review of the literature was performed in January 2007 using MEDLINE, Embase, and Web of Science. The searches used both ‘‘MeSH’’ and ‘‘free text’’ protocols. Meta-analysis was conducted using the Review Man- ager software 4.2 (Cochrane Collaboration). Results: Our search identified 37 randomized controlled trials. According to the Jadad score, the quality of the evaluated studies was limited in most papers. TVT outperformed Burch colposuspension in terms of postoperative continence rates (odds ratio [OR] from 0.38 to 0.59, according to the different end points), whereas success rates were similar after TVT and pubovaginal slings. Comparing TVT to the other retropubic tension-free midurethral vaginal slings, TVT was more efficacious than both intravaginal slingplasty (IVS; OR = 0.47; p = 0.007) and suprapubic arc (SPARC; OR from 0.53 to 0.56 according to the different evaluated end points). Indeed, the available data suggest similar efficacy for retropubic and trans-obturator tapes both in terms of subjective (OR = 0.98; p = 0.92) and objec- tive (OR = 0.81; p = 0.34) cure rates. Conclusions: Our meta-analysis showed that TVT outperformed Burch colposus- pension; efficacies of TVT and pubovaginal sling were similar. TVT was more efficacious than IVS and SPARC, whereas retropubic and trans-obturator tapes showed overlapping cure rates. The poor quality of most of the studies, both in terms of methodologic and clinical parameters, limits the strengths of the recommendations derived by the meta-analysis. # 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Monoblocco Ospedaliero, IV Floor, Via Giustiniani 2, 35128, Padua, Italy. Tel. +39 049 8212720; Fax: +39 049 8218757. E-mail address: walter.artibani@unipd.it (W. Artibani). 0302-2838/$ – see back matter # 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2007.06.018