Preoperative Risk Factors for Failure After Fixed Sling Implantation for Postprostatectomy Stress Urinary Incontinence (FORESEE): A Systematic Review and Meta-analysis.

Background and objective: Controversy exists regarding factors affecting the efficacy of fixed male slings. We aimed to systematically evaluate preoperative prognosticators for failure after fixed sling implantation (PROSPERO registration: CRD42022307160). Methods: A systematic search was conducted in the PubMed/MEDLINE, Web of Science, Scopus, and Cochrane databases, from inception up to September 2024, and in the reference lists of retrieved articles. Studies with at least 30 patients, with 6 mo of follow-up, and evaluating the association between at least one factor and continence outcomes (cure and/or overall success) were included. We performed separate meta-analyses for adjusted and unadjusted odds ratios using a random-effect model with Hartung-Knapp adjustment. Study quality was evaluated by the Quality in Prognostic Studies tool, certainty in evidence was assessed according to the Grading of Recommendations, Assessment, Development, and Evaluations framework, and a review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. Key findings and limitations: Sixty-two cohorts from 65 papers, involving 5696 patients, were included. Studies, mostly single centre (57%) and retrospective (74%), investigated 78 risk factors, generating 509 effect sizes and 70 meta-analyses. We found eight risk factors, with high certainty for pelvic irradiation, 24-h pad use, and 24-h urine loss, and moderate certainty for urethral stricture, previous incontinence therapy, detrusor overactivity, higher Male Stress Incontinence Grading Scale score, and unfavourable repositioning test. Age and time from prostatectomy did not appear to affect slings outcomes (moderate certainty). Low/very low certainty was found for several other variables. Heterogeneity and suboptimal study quality are the main limitations. Conclusions and clinical implications: Within the limits of existing literature, we found several risk factors for the failure of fixed slings. This information will assist health care professionals in patient selection and counselling. Patient summary: We reviewed the published literature on factors that may influence the efficacy of fixed slings for treating urinary incontinence after prostate surgery. We found evidence that some patient characteristics affect the likelihood of incontinence improvement after sling implantation. This information may assist in the choice of the best incontinence treatment.