To systematically review objective and subjective success, and surgical outcomes of sub-urethral sling surgery for female patients with stress or mixed urinary incontinence (SUI, MUI) using synthetic vs. non-synthetic material with corresponding surgical approach (retropubic, RP or transobturator, TO). We systematically searched Medline, Embase, EBM Reviews, and Web of Science Core Collection using standardized medical subject headings, no date restrictions (Prospero registered). We double-screened studies and used backward citation chaining. We included peer-reviewed randomized controlled trials and prospective or retrospective comparative studies examining outcomes of RP or TO synthetic vs non-synthetic (autologous, allograft, xenograft) slings for female SUI or MUI, with available English or French full text. We excluded minislings (single insertion point). We allowed slings for recurrent SUI or MUI, and slings concomitant with prolapse surgery, with at least 6 weeks of postoperative follow-up. We excluded systematic reviews, meta-analyses, review studies, case-control studies, case reports, studies that did not describe surgical approach or material, and studies of combination slings. We evaluated study quality using the Cochrane Risk of Bias Tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. We used pooled relative risk (RR) with 95% confidence intervals (CI) to estimate effect of sling material type on each outcome through meta-analysis and meta-regression as appropriate. We screened 4341 abstracts, assessed 104 full-texts and retained 35 manuscripts (30 separate studies). For RP synthetic vs non-synthetic, there was no difference in number of objectively or subjectively continent patients. Reoperation for SUI and overall was higher for non-autologous RP slings compared to synthetic. RP synthetic vs autologous slings were associated with higher subjective continence in populations with ≥ 25% recurrent SUI (RR 1.27, 95% CI 1.12-1.43). For TO synthetic vs non-synthetic, there were no differences in continence. Subjective satisfaction was better in the TO synthetic group compared to autologous (RR 1.42, 95% CI 1.03;1.94). Synthetic and non-synthetic slings have comparable objective and subjective success, with differences in operative outcomes and complications generally in favour of synthetic material.

中文翻译：

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合成与非合成吊带治疗女性压力和混合性尿失禁：系统评价和荟萃分析

系统评价使用合成材料与非合成材料以及相应手术方法（耻骨后、RP 或经闭孔、到）。我们使用标准化医学主题标题系统地检索了 Medline、Embase、EBM Reviews 和 Web of Science 核心合集，没有日期限制（Prospero 已注册）。我们对研究进行了双重筛选并使用了反向引用链。我们纳入了同行评审的随机对照试验和前瞻性或回顾性比较研究，检查 RP 或 TO 合成与非合成（自体、同种异体、异种移植）吊带对女性 SUI 或 MUI 的结果，并提供英文或法文全文。我们排除了迷你吊带（单个插入点）。我们允许使用吊带治疗复发性 SUI 或 MUI，以及与脱垂手术同时使用吊带，并进行至少 6 周的术后随访。我们排除了系统评价、荟萃分析、综述研究、病例对照研究、病例报告、未描述手术方法或材料的研究以及组合吊带的研究。我们使用 Cochrane 偏差风险工具进行随机对照试验和纽卡斯尔-渥太华量表进行观察性研究来评估研究质量。我们使用具有 95% 置信区间 (CI) 的汇总相对风险 (RR)，通过适当的荟萃分析和荟萃回归来估计吊带材料类型对每个结果的影响。我们筛选了 4341 篇摘要，评估了 104 篇全文并保留了 35 篇手稿（30 项独立研究）。对于 RP 合成与非合成，客观或主观节制患者的数量没有差异。与合成吊带相比，非自体 RP 吊带的 SUI 和整体再次手术率更高。RP 合成吊带与自体吊带相比，在复发性 SUI ≥ 25% 的人群中与较高的主观控制能力相关（RR 1.27，95% CI 1.12-1.43）。对于合成 TO 与非合成 TO 而言，节制能力没有差异。与自体同体组相比，TO 合成组的主观满意度更好（RR 1.42，95% CI 1.03；1.94）。合成和非合成吊带具有相当的客观和主观成功率，但手术结果和并发症的差异通常有利于合成材料。