***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE As part of a continuous quality control effort to measure the interrater reliability of urodynamic studies performed at multiple centers , we compared agreement levels for urodynamic studies between central and local physician review ers . We report interrater reliability findings for the filling cystometrogram . MATERIAL S AND METHODS Following a satisfactory interrater reliability study among 4 central physician review ers in 33 tracings 36 urodynamic study tracings from 9 Urinary Incontinence Treatment Network continence treatment centers and 13 Urinary Incontinence Treatment Network certified urodynamic study testers were r and omly selected for review . These tracings were originally interpreted by 11 local physician review ers using st and ardized Urinary Incontinence Treatment Network interpretation guidelines . Each of the 4 central physician review ers review ed 9 r and omly assigned tracings and none review ed tracings from his or her center . Local and central physician review ers were instructed to categorize values as invalid if specified technical quality assurance st and ards were not met or the signal pattern suggested implausible values because of technical deficiencies . An intraclass correlation coefficient was calculated for continuous ( numerical ) variables and a kappa statistic was calculated for qualitative values with acceptable agreement defined a priori as an intraclass correlation coefficient of greater than 0.6 . RESULTS Filling cystometrogram baseline pressure , Valsalva leak point pressure , and volume and pressure measurements at maximum cystometric capacity had excellent intraclass correlation coefficients of 0.74 to 0.99 . There were no significant differences between local and central physician review er means , indicating excellent agreement . CONCLUSIONS With proper quality control measures in place and a set of st and ardized interpretive guidelines excellent interrater reliability between local and central physician review er can be achieved for numerical cystometrogram variables Introduction and HypothesisTo compare 1-year surgical outcomes following transobturator ( TO ) sling placement and single incision ( SI ) sling placement for the treatment of stress urinary incontinence ( SUI ) . Methods We performed a r and omized trial at a single institution . Patients with urodynamically proven SUI were offered participation and r and omized to placement of a TO sling ( Monarc ™ ) or a SI sling ( MiniArc ™ ) between 2008 and 2011 . The primary outcome measure was urinary leakage during st and ardized cough stress test ( CST ) . Forty subjects in each group were required to achieve 80 % power to detect an effect size of 0.25 . Results A total of 98 patients were r and omized with 49 patients in the TO group and 49 patients in the SI group . Preoperative demographics were similar between the groups ( Table 1 ) . The TO group had a significantly longer sling operative time ( 10.7 ± 4.8 min vs. 7.8 ± 4.9 min , p < 0.001 ) and greater estimated blood loss ( 31.6 ± 26.6 mL vs. 22.9 ± 22.1 mL , p = 0.02 ) . At the 1-year follow-up , there was no difference in the primary outcome with 9 TO patients ( 21 % ) and 12 SI patients ( 29 % ) having a positive CST ( p = 0.5 ) . A composite measurement of ‘ failure ’ , defined as patient-reported SUI and a positive CST , showed no difference between the TO group ( 17 % ) and the SI group ( 27 % ; p = 0.3 ) . Conclusions The SI sling provides comparable objective efficacy to the TO sling at 1 year OBJECTIVE To compare peri-operative complications , pain , and the immediate functional results of the sub-urethral sling procedure for urinary stress incontinence by the retropublic and transobturator routes , using a non-elastic polypropylene sub-urethral sling . PATIENTS AND METHODS This prospect i ve , multicentre study involved 88 women undergoing the sub-urethral sling procedure for stress urinary incontinence ( SUI ) . The retropubic route ( RPR ) and the transobturator route ( TOR ) were used in respectively 42 and 46 cases . The characteristics of the women in the RPR and TOR groups were as follows : mean age ( + /-st and ard deviation ) 56.8+/-12 years and 53.4+/-10 years , respectively ; mean BMI : 25+/-4 and 26+/-4 ; mean parity : 2.1+/-0.9 and 2+/-1 children ; post-menopausal status : 66.7 % and 58.7 % ; prior surgery for SUI : 7.1 % and 6.5 % ; and prior hysterectomy : 21.4 % and 26.1 % . None of these characteristics differed significantly between the groups . Likewise , pre-operative urinary functional status ( SUI stage , and pollakiuria , nocturia and urgency rates ) was similar in the two groups . RESULTS Mean hospital stay and overall morbidity rate were not significantly different between the RPR and TOR groups . Mean operating time was longer in the RPR group . Bladder injury was significantly more frequent in the RPR group and vaginal injury was significantly more frequent in the TOR group . Pain scores were significantly lower in the TOR group . The objective functional results at one month did not differ between the groups . Quality of life , evaluated with question naires and numerical rating scales , was similarly improved in the two groups . DISCUSSION The suburethral sling procedure was less painful by the TOR route than by the RPR route . Bladder injury , haematomas and abscesses were only observed in the RPR group , while vaginal injury only occurred in the TOR group . The immediate functional results of the two approaches were similar OBJECTIVE : To compare the efficacy of a single-incision mini-sling , placed in the “ U ” position , with tension-free vaginal tape ( TVT ) in the treatment of stress urinary incontinence . METHODS : Women with urodynamic stress incontinence with or without genital prolapse were r and omized to receive a mini-sling or TVT ( N=263 ) . Those r and omized to the mini-sling received two “ sham ” suprapubic incisions to facilitate blinding . The primary outcome was subjective cure ( absence of any urinary incontinence or retreatment ) as assessed at 1 year . This trial was a noninferiority study design . RESULTS : Participants receiving the mini-sling  were less likely to have a bladder injury ( 0.8 % compared with 4.8 % ; P=.0.46 ) , more likely to be discharged without a catheter ( 78.5 % compared with 63 % ; P=.008 ) , and had less pain for postoperative days 1–3 . One year after surgery , the rate of cure was similar between treatment groups ( mini-sling 55.8 % compared with TVT 60.6 % ; mean difference , 4.8 % ; 95 % confidence interval , −16.7 to + 7.2 ) ; however , this did not meet our predefined noninferiority criteria of −12 % . Incontinence severity at 1 year was greater with the mini-sling than with TVT ( mean severity score ± SD : 2.2±2.7 compared with 1.5±1.9 ; P=.015 ) , result ing predominantly from a higher proportion of participants with “ severe ” incontinence postoperatively ( 16 % compared with 5 % ; P=.025 ) . CONCLUSION : The mini-sling placed in the “ U ” position results in similar subjective cure rates  to TVT 1 year after surgery but postoperative incontinence severity is greater with the mini-sling than with TVT . LEVEL OF EVIDENCE : Introduction and hypothesisThe aim of this prospect i ve r and omized multicenter study was to compare retropubic tension-free vaginal tape ( TVT ) with TVT Secur in terms of efficacy and safety . Methods We set out to enrol 280 stress urinary incontinent ( SUI ) women with a half-time interim analysis of short-term cure and adverse events . The short-term results have previously been published . Of the133 r and omized women , 125 underwent surgery , and 121 ( TVT n = 61 , TVT Secur n = 60 ) were available for follow-up 1 year postsurgery . Results No significant differences were found between groups regarding demographics or incontinence grade . One year after surgery , both subjective and objective cure rates were significantly lower for TVT Secur than for TVT ( subjective cure : TVT 98 % , TVT Secur 80 % , p = 0.03 ; objective cure : TVT 94 % , TVT Secur 71 % for cough test , p = 0.01 ; TVT 76 % , TVT Secur 58 % for pad test , p = 0.05 ) . Three major complications occurred in the TVT Secur group : one tape erosion into the urethra , one tape inadvertently placed into the bladder , and one immediate postoperative bleeding due to injury to the corona mortis . No major complications occurred in the TVT group . No significant differences were found between groups regarding peroperative bleeding , hospital stay , urge symptoms , residual urinary volume , subjective bladder emptying problems , postoperative urinary tract infections , and minor complications . The TVT Secur group used more antimuscarine medication after surgery than the TVT group ( p = 0.03 ) . Median time for surgery was 13 and 22 min for TVT Secur and TVT , respectively ( p < 0.0001 ) . Conclusion The TVT Secur procedure had significantly inferior subjective and objective cure rates compared with the retropubic TVT procedure . Three serious adverse events occurred in the TVT Secur group . We therefore discourage further use of TVT Secur Background : The aim of this study is to evaluate the outcome of an innovative , minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse ( AVWP ) . Material s and Methods : Fifty-six women with stress urinary incontinence ( SUI ) or mixed urinary incontinence and AVWP were r and omly assigned into two groups : In Group A ( 26 patients ) , anterior colporrhaphy ( Kelly placation ) and sling placement using a strip of anterior vaginal wall were performed , and in Group B ( 30 patients ) , transvaginal mesh correction of AVWP and tension-free vaginal tape ( TVT ) insertion ( retropubic – craniocaudal route ) using polypropylene mesh were carried out . The patients were followed-up for over 18 months and were assessed objective ly using a 48 h frequency-volume chart , a 48 h pad test and a st and ardized stress test . Related surgical complications and outcomes were recorded and compared . Results : Surgical cure rates for Group A and Group B at the first ( 3 days ) and last ( 18 months ) post-operative visits were 62 % and 84 % ; and 54 % , and 72 % , respectively ( P = 0.09 and 0.31 ) . Complications occurred in 9 patients ( 44 % ) of Group B , but only 3 patients ( 12 % ) in Group A. Conclusion : Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates . Although , the surgical success rate of this technique is lower than T-Sling , larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery OBJECTIVE The purpose of this study was to prospect ively and r and omly compare tension-free vaginal tape ( TVT ) with transobturator suburethral tape ( T.O.T. ) for the surgical treatment of stress urinary incontinence ( SUI ) in women . STUDY DESIGN Sixty-one women with SUI were r and omly assigned to either TVT ( n=31 ) or T.O.T. ( n=30 ) . The preoperative evaluation included a quality -of-life question naire and a comprehensive urodynamic examination . The 1-year outcome included a detrusor pressure-uroflow study to compare bladder outlet obstruction . RESULTS Patient characteristics , preoperative quality of life , and urodynamic evaluation were similar in the 2 groups . Mean operative time was significantly shorter in the T.O.T. group ( 15 min+/-4 vs 27 min+/-8 , P<.001 ) . No bladder injury occurred in the T.O.T. group versus 9.7 % ( n=3 ) in the TVT group ( P>.05 ) . The rate of postoperative urinary retention was 25.8 % ( n=8 ) in the TVT group versus 13.3 % ( n=4 ) in the T.O.T. group ( P>.05 ) . The rates of cure ( 83.9 % vs 90 % ) , improvement ( 9.7 % vs 3.3 % ) , and failure ( 6.5 % vs 6.7 % ) were similar for the TVT and T.O.T. groups , respectively . The 1-year outcome data were collected in 29 women of the TVT group and 27 women of the T.O.T. group . No vaginal erosion occurred in either of the groups . In terms of bladder outlet obstruction , no differences were found after TVT and T.O.T. CONCLUSION T.O.T. appears to be equally efficient as TVT for surgical treatment of stress urinary incontinence in women , with no reduction of bladder outlet obstruction at 1-year follow-up Fifty consecutive female patients with genuine urinary stress incontinence were r and omized either to surgery or to a pelvic floor training program . The operative procedure 
    Output:
    
The NMA , which included 120 studies that reported data on ' cure ' or ' improvement ' , showed that retropubic mid-urethral sling ( MUS ) , transobturator MUS , traditional sling and open colposuspension were more effective than other surgical procedures for both primary outcomes .
The results for other interventions were variable .
In general , rate of tape and mesh exposure was higher after transobturator MUS than after retropubic MUS or single-incision sling , whereas the rate of tape or mesh erosion/extrusion was similar between transobturator MUS and retropubic MUS .
The results of the DCE , in which 789 women completed an anonymous online question naire , indicate that women tend to prefer surgical treatments associated with no pain or mild chronic pain and shorter length of hospital stay as well as those treatments that have a smaller risk for urinary symptoms to reoccur after surgery .
The cost-effectiveness results suggest that , over a lifetime , retropubic MUS is , on average , the least costly and most effective surgery .
The VOI analysis highlighted that further research around the incidence rates of complications would be of most value .
To our knowledge , this is the most comprehensive assessment of published evidence for the treatment of SUI .
There is some evidence that retropubic MUS , transobturator MUS and traditional sling are effective in the short to medium term and that retropubic MUS is cost-effective in the medium to long term .
The VOI analysis highlights the value of further research to reduce the uncertainty around the incidence rates of complications .