This NIHR HTA-funded project is the most comprehensive assessment of the current evidence for the clinical effectiveness, safety and cost-effectiveness of surgical treatments for stress urinary incontinence (SUI) in women. Nine surgical interventions to treat SUI were compared. Previous Cochrane reviews for each intervention were identified and update searches were conducted to identify additional studies. Both pair-wise and network meta-analyses (NMAs) were conducted for all available surgical comparisons. A discrete choice experiment (DCE) was undertaken to assess the preferences of women for treatment outcomes.

An economic model assessed the cost-effectiveness of alternative surgeries and a value of information (VOI) analysis undertaken. Data from 175 studies were included in the effectiveness review. The NMA results, which included 121 studies that reported data on ‘cure’ or ‘improvement’, and those of the cost-effectiveness analyses indicate that retropubic MUS, transobturator MUS traditional sling, and open colposuspension are more effective than other surgical procedures in the short to medium term and that retropubic MUS is cost-effective in the medium to long term.

However, there is a lack of high quality long-term data especially for the assessment of complications. The results of the DCE, where 789 women completed an anonymous online questionnaire, indicate that women tend to prefer surgical treatments associated with no or mild chronic pain and shorter length of hospital stay, as well as those treatments that have a smaller risk for urinary symptoms to re-occur after surgery.





Completed report published on 29 March 2019 in the NIHR Journals Library Health Technol Assess 2019;23(14)