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This week in the British Medical Journal Imamura and colleagues report a Metanalysis of surgical interventions for stress urinary incontinence (SUI). BMJ 2019;365:I1842.

A metanalysis is a detailed systematic review of previous research on a subject. There were a total of 21598 women included in the studies that were considered, comparing different types of surgery for women who leak urine when they cough, sneeze or exert themselves. this effects about 10% of women.

The biggest studies compare different types of surgery using synthetic tapes (mesh) with each other other or with more conventional surgery. All the studies are of rather short duration and don’t help us to define long term outcomes or rare adverse events. There is currently a moratorium on the use of these mid urethral slings, even though they have the best success success rates, because of concerns over their long term safety. It may also be the case that there are long term safety concerns with our conventional surgery.

There is a growing consensus that we may reject the mid urethral slings only to find that our conventional operations, which are less effective, are also less safe.

One operation involving bulking injection into the urethra (Bulkamid) is gaining popularity, for whilst it is less effective, there is little possibility for long term complications.