De novo overactive bladder following midurethral sling procedures: a systematic review of the literature and meta-analysis

Introduction and hypothesis

De novo overactive bladder (OAB) is a known complication of midurethral sling surgery for the treatment of stress urinary incontinence. To date, differences in the incidence of de novo OAB following the use of different types of midurethral sling remain relatively unknown. The purpose of the present systematic review was to evaluate this incidence and summarize current evidence.

Methods

We systematically searched the literature using the MEDLINE, Embase, Scopus, ClinicalTrials.gov, LILACS and Cochrane Central Register of Controlled Trials databases as well as the grey literature and references from the electronically retrieved articles. For comparisons of proportions, we used the chi-squared test. All reported analyses were designed as two-tailed. Statistical significance was set at p < 0.05.

Results

Finally, 32 studies were included in this systematic review, with a total of 3,139 patients who had undergone midurethral sling procedures that included transobturator tapes (TOT), retropubic tapes (TVT) or single-incision tapes (mini-slings). The overall incidence of de novo OAB was 11.5% in nonrandomized studies (280 women) and 6.4% in randomized studies (50 women). In relation to the type of midurethral sling, the incidence of de novo OAB was 9.7% for mini-slings, 11.2% for TVT-O, 8.7% for TOT and 9.8% for TVTs. The chi-squared test did not reveal significant differences (p = 0.58).

Conclusions

Current evidence suggests that the overall incidence of de novo OAB following midurethral sling procedures is approximately 9%. There is not enough evidence to support differences in the effects of the different types of sling with regard to this particular postoperative complication.

     

Hearing thresholds in an auto assembly plant: prospects for hearing conservation in an Nigerian factory

Summary The hearing of 165 auto assembly workers exposed to noise levels of between 94 and 108 dB was assessed by means of air and bone conductance audiograms obtained during peak and low production periods to determine acute shifts in hearing. Compared to non-industrially exposed and non-production subgroups, the exposed subjects had significantly (P < 0.001) elevated thresholds at both peak and low production periods. There was an acute and significant (P < 0.001) drop in the hearing thresholds of the exposed subjects during low production period. This was especially true of cross-sections of the exposed subjects and of a cohort specifically sampled at both high and low production periods. Hearing thresholds for the exposed subjects increased with both age and duration of employment and were significantly correlated with duration of employment (P < 0.05). Of all the confounders (age, duration of employment, residential density) assessed by stepwise multiple regression analysis, duration of employment was the only significant contributor to the threshold shift. There was no conductive deafness among the study subjects. There was no consistent association between blood pressure and either hearing threshold or noise level. The results indicate good prospects for hearing conservation for Nigeria workers if hearing protection and noise abatement programs, currently not mandated by statutes, can be instituted.