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Meta-Analysis
. 2016 Oct 1;10(10):CD012376.
doi: 10.1002/14651858.CD012376.

Surgery for women with apical vaginal prolapse

Christopher Maher  1 , Benjamin Feiner, Kaven Baessler, Corina Christmann-Schmid, Nir Haya, Julie Brown
Affiliations
Meta-Analysis

Surgery for women with apical vaginal prolapse

Christopher Maher et al. Cochrane Database Syst Rev. .

Update in

  • Surgery for women with apical vaginal prolapse.
    Maher C, Yeung E, Haya N, Christmann-Schmid C, Mowat A, Chen Z, Baessler K. Maher C, et al. Cochrane Database Syst Rev. 2023 Jul 26;7(7):CD012376. doi: 10.1002/14651858.CD012376.pub2. Cochrane Database Syst Rev. 2023. PMID: 37493538 Free PMC article.

Abstract

Background: Apical vaginal prolapse is a descent of the uterus or vaginal vault (post-hysterectomy). Various surgical treatments are available and there are no guidelines to recommend which is the best.

Objectives: To evaluate the safety and efficacy of any surgical intervention compared to another intervention for the management of apical vaginal prolapse.

Search methods: We searched the Cochrane Incontinence Group's Specialised Register of controlled trials, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched July 2015) and ClinicalTrials.gov (searched January 2016).

Selection criteria: We included randomised controlled trials (RCTs).

Data collection and analysis: We used Cochrane methods. Our primary outcomes were awareness of prolapse, repeat surgery and recurrent prolapse (any site).

Main results: We included 30 RCTs (3414 women) comparing surgical procedures for apical vaginal prolapse. Evidence quality ranged from low to moderate. Limitations included imprecision, poor methodological reporting and inconsistency. Vaginal procedures versus sacral colpopexy (six RCTs, n = 583; one to four-year review). Awareness of prolapse was more common after vaginal procedures (risk ratio (RR) 2.11, 95% confidence interval (CI) 1.06 to 4.21, 3 RCTs, n = 277, I2 = 0%, moderate-quality evidence). If 7% of women are aware of prolapse after sacral colpopexy, 14% (7% to 27%) are likely to be aware after vaginal procedures. Repeat surgery for prolapse was more common after vaginal procedures (RR 2.28, 95% CI 1.20 to 4.32; 4 RCTs, n = 383, I2 = 0%, moderate-quality evidence). The confidence interval suggests that if 4% of women require repeat prolapse surgery after sacral colpopexy, between 5% and 18% would require it after vaginal procedures.We found no conclusive evidence that vaginal procedures increaserepeat surgery for stress urinary incontinence (SUI) (RR 1.87, 95% CI 0.72 to 4.86; 4 RCTs, n = 395; I2 = 0%, moderate-quality evidence). If 3% of women require repeat surgery for SUI after sacral colpopexy, between 2% and 16% are likely to do so after vaginal procedures. Recurrent prolapse is probably more common after vaginal procedures (RR 1.89, 95% CI 1.33 to 2.70; 4 RCTs, n = 390; I2 = 41%, moderate-quality evidence). If 23% of women have recurrent prolapse after sacral colpopexy, about 41% (31% to 63%) are likely to do so after vaginal procedures.The effect of vaginal procedures on bladder injury was uncertain (RR 0.57, 95% CI 0.14 to 2.36; 5 RCTs, n = 511; I2 = 0%, moderate-quality evidence). SUI was more common after vaginal procedures (RR 1.86, 95% CI 1.17 to 2.94; 3 RCTs, n = 263; I2 = 0%, moderate-quality evidence). Dyspareunia was also more common after vaginal procedures (RR 2.53, 95% CI 1.17 to 5.50; 3 RCTs, n = 106, I2 = 43%, low-quality evidence). Vaginal surgery with mesh versus without mesh (6 RCTs, n = 598, 1-3 year review). Awareness of prolapse - There may be little or no difference between the groups for this outcome (RR 1.08 95% CI 0.35 to 3.30 1 RCT n = 54, low quality evidence). The confidence interval was wide suggesting that if 18% of women are aware of prolapse after surgery without mesh, between 6% and 59% will be aware of prolapse after surgery with mesh. Repeat surgery for prolapse - There may be little or no difference between the groups for this outcome (RR 0.69, 95% CI 0.30 to 1.60; 5 RCTs, n = 497; I2 = 9%, low-quality evidence). If 4% of women require repeat surgery for prolapse after surgery without mesh, 1% to 7% are likely to do so after surgery with mesh.We found no conclusive evidence that surgery with mesh increases repeat surgery for SUI (RR 4.91, 95% CI 0.86 to 27.94; 2 RCTs, n = 220; I2 = 0%, low-quality evidence). The confidence interval was wide suggesting that if 2% of women require repeat surgery for SUI after vaginal colpopexy without mesh, 2% to 53% are likely to do so after surgery with mesh.We found no clear evidence that surgery with mesh decreases recurrent prolapse (RR 0.36, 95% CI 0.09 to 1.40; 3 RCTs n = 269; I2 = 91%, low-quality evidence). The confidence interval was very wide and there was serious inconsistency between the studies. Other outcomes There is probably little or no difference between the groups in rates of SUI (de novo) (RR 1.37, 95% CI 0.94 to 1.99; 4 RCTs, n = 295; I2 = 0%, moderate-quality evidence) or dyspareunia (RR 1.21, 95% CI 0.55 to 2.66; 5 RCTs, n = 501; I2 = 0% moderate-quality evidence). We are uncertain whether there is any difference for bladder injury (RR 3.00, 95% CI 0.91 to 9.89; 4 RCTs, n = 445; I2 = 0%; very low-quality evidence). Vaginal hysterectomy versus alternatives for uterine prolapse (six studies, n = 667)No clear conclusions could be reached from the available evidence, though one RCT found that awareness of prolapse was less likely after hysterectomy than after abdominal sacrohysteropexy (RR 0.38, 955 CI 0.15 to 0.98, n = 84, moderate-quality evidence).Other comparisonsThere was no evidence of a difference for any of our primary review outcomes between different types of vaginal native tissue repair (two RCTs), comparisons of graft materials for vaginal support (two RCTs), different routes for sacral colpopexy (four RCTs), or between sacral colpopexy with and without continence surgery (four RCTs).

Authors' conclusions: Sacral colpopexy is associated with lower risk of awareness of prolapse, recurrent prolapse on examination, repeat surgery for prolapse, postoperative SUI and dyspareunia than a variety of vaginal interventions.The limited evidence does not support use of transvaginal mesh compared to native tissue repair for apical vaginal prolapse. Most of the evaluated transvaginal meshes are no longer available and new lighter meshes currently lack evidence of safetyThe evidence was inconclusive when comparing access routes for sacral colpopexy.No clear conclusion can be reached from the available data comparing uterine preserving surgery versus vaginal hysterectomy for uterine prolapse.

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Conflict of interest statement

The lead review author, Christopher Maher, is an author of two of the included trials (Maher 2004; Maher 2011). No authors have any conflict of interest to declare.

Figures

1
1
PRISMA study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Forest plot of comparison: 1 Vaginal procedure versus sacral colpopexy, outcome: 1.1 Awareness of prolapse (2 years).
5
5
Forest plot of comparison: 1 Vaginal procedure versus sacral colpopexy, outcome: 1.2 Repeat surgery (2‐4 years).
6
6
Forest plot of comparison: 1 Vaginal procedure versus sacral colpopexy, outcome: 1.3 Any recurrent prolapse (1‐2 years).
7
7
Forest plot of comparison: 1 Vaginal procedure versus sacral colpopexy, outcome: 1.12 Dyspareunia.
8
8
Forest plot of comparison: 2 Vaginal surgery with mesh versus without mesh, outcome: 2.3 Recurrent prolapse on examination (1‐3 years).
1.1
1.1. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 1 Awareness of prolapse (2 years).
1.2
1.2. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 2 Repeat surgery (2‐4 years).
1.3
1.3. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 3 Any recurrent prolapse (1‐2 years).
1.4
1.4. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 4 Mesh exposure (1‐4 years).
1.5
1.5. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 5 Injuries.
1.6
1.6. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 6 Repeat surgery for mesh exposure (2‐4 years).
1.7
1.7. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 7 Objective failure (2‐4 years).
1.8
1.8. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 8 POPQ assessment (2 years).
1.9
1.9. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 9 Stress urinary incontinence (2 years).
1.10
1.10. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 10 Urge incontinence (de novo (2 years).
1.11
1.11. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 11 Urinary Voiding dysfunction (de novo).
1.12
1.12. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 12 Dyspareunia.
1.13
1.13. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 13 Sexual function.
1.14
1.14. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 14 Quality of life and satisfaction (4 years).
1.15
1.15. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 15 Operating time (minutes).
1.16
1.16. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 16 Length of hospital stay.
1.17
1.17. Analysis
Comparison 1 Vaginal procedure versus sacral colpopexy, Outcome 17 Blood transfusion.
2.1
2.1. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 1 Awareness of prolapse (3 years).
2.2
2.2. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 2 Repeat surgery (1‐3 years).
2.3
2.3. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 3 Recurrent prolapse on examination (1‐3 years).
2.4
2.4. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 4 Injuries.
2.5
2.5. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 5 Objective failure.
2.6
2.6. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 6 POPQ assessment (1 year).
2.7
2.7. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 7 Stress urinary incontinence (1‐3 years)).
2.8
2.8. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 8 Urge incontinence.
2.9
2.9. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 9 Voiding dysfunction.
2.10
2.10. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 10 Dyspareunia (1‐3 years).
2.11
2.11. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 11 Pelvic organ prolapse/ urinary incontinence sexual questionnaire (PISQ) (1 year).
2.12
2.12. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 12 Patient Global Impression of Improvement (PGI‐I)( much or very much better 3 years).
2.13
2.13. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 13 Quality of life PROLAPSE.
2.14
2.14. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 14 Operating time (mins).
2.15
2.15. Analysis
Comparison 2 Vaginal surgery with mesh versus without mesh, Outcome 15 Blood transfusion.
3.1
3.1. Analysis
Comparison 3 Vaginal surgery: comparison of one native tissue repair versus another, Outcome 1 Awareness of prolapse (2 years).
3.2
3.2. Analysis
Comparison 3 Vaginal surgery: comparison of one native tissue repair versus another, Outcome 2 Repeat surgery (2 years).
3.3
3.3. Analysis
Comparison 3 Vaginal surgery: comparison of one native tissue repair versus another, Outcome 3 Injuries.
3.4
3.4. Analysis
Comparison 3 Vaginal surgery: comparison of one native tissue repair versus another, Outcome 4 Objective failure.
3.5
3.5. Analysis
Comparison 3 Vaginal surgery: comparison of one native tissue repair versus another, Outcome 5 POPQ assessment.
3.6
3.6. Analysis
Comparison 3 Vaginal surgery: comparison of one native tissue repair versus another, Outcome 6 Stress urinary incontinence de novo(1 year).
3.7
3.7. Analysis
Comparison 3 Vaginal surgery: comparison of one native tissue repair versus another, Outcome 7 Urge incontinence.
3.8
3.8. Analysis
Comparison 3 Vaginal surgery: comparison of one native tissue repair versus another, Outcome 8 Dyspareunia (1 year).
3.9
3.9. Analysis
Comparison 3 Vaginal surgery: comparison of one native tissue repair versus another, Outcome 9 Blood transfusion.
4.1
4.1. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 1 Awareness of prolapse.
4.2
4.2. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 2 Repeat prolapse surgery.
4.3
4.3. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 3 Objective failure any site (POP).
4.4
4.4. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 4 Bladder injuries.
4.5
4.5. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 5 Bowel injuries (1 year review).
4.6
4.6. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 6 Mesh exposure.
4.8
4.8. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 8 Repeat surgery for incontinence.
4.9
4.9. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 9 Anterior compartment prolapse ( 1 year review).
4.10
4.10. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 10 Apical compartment prolapse.
4.11
4.11. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 11 Posterior compartment prolapse.
4.12
4.12. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 12 POPQ assessment Point Ba.
4.13
4.13. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 13 POPQ assessment: Point Bp.
4.14
4.14. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 14 POPQ assessment: Point C.
4.15
4.15. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 15 POPQ assessment: Total vaginal length.
4.16
4.16. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 16 Dyspareunia.
4.17
4.17. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 17 Quality of life:Pelvic organ prolapse/ urinary incontinence sexual questionnaire.
4.18
4.18. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 18 Operating time (minutes).
4.19
4.19. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 19 Hospital stay.
4.20
4.20. Analysis
Comparison 4 Vaginal hysterectomy vs alternatives for uterine prolapse, Outcome 20 Blood transfusion.
5.1
5.1. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 1 Awareness of prolapse (1‐5 years).
5.2
5.2. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 2 Prolapse surgery (1‐5 year).
5.3
5.3. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 3 Surgery stress urinary incontinence 5 years.
5.4
5.4. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 4 Recurrent prolapse (any site on examination (1‐5 year)).
5.5
5.5. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 5 Mesh exposure (1‐5 year).
5.6
5.6. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 6 Bladder injury.
5.7
5.7. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 7 Bowel injury.
5.8
5.8. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 8 Surgery mesh exposure 1‐5 years.
5.9
5.9. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 9 apical prolapse.
5.10
5.10. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 10 POPQ assessment.
5.11
5.11. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 11 Dyspareunia (de novo 1 year)).
5.12
5.12. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 12 Sexual function.
5.13
5.13. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 13 Quality of life PROLAPSE (i year).
5.14
5.14. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 14 Operating time (mins).
5.15
5.15. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 15 Hospital stay.
5.16
5.16. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 16 Blood transfusion.
5.17
5.17. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 17 pain at normal acivities (week one).
5.18
5.18. Analysis
Comparison 5 Sacral colpopexy mesh versus biological, Outcome 18 Surgery or pessary for prolapse.
6.1
6.1. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 1 Repeat Prolapse Surgery.
6.2
6.2. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 2 Recurrent prolapse (any site on examination).
6.3
6.3. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 3 Mesh exposure.
6.4
6.4. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 4 Bladder injury.
6.5
6.5. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 5 Bowel injury.
6.6
6.6. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 6 Point Ba.
6.7
6.7. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 7 Point Bp.
6.8
6.8. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 8 Point C.
6.9
6.9. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 9 Stress urinary incontinence (de novo and persistent).
6.10
6.10. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 10 Quality of life PROLAPSE.
6.11
6.11. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 11 Operating time (mins).
6.12
6.12. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 12 Hospital stay.
6.13
6.13. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 13 Blood transfusion.
6.14
6.14. Analysis
Comparison 6 Sacral colpopexy: Laparoscopic versus other, Outcome 14 continence surgery.
7.1
7.1. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 1 Awareness of prolapse (7 years).
7.2
7.2. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 2 Repeat prolapse surgery or pessary (2‐7 years)).
7.3
7.3. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 3 Repeat surgery for incontinence (7 years)).
7.4
7.4. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 4 Objective failure any site (POP 7 years).
7.5
7.5. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 5 POPQ assessment Point Ba.
7.6
7.6. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 6 POPQ assessment: Point Bp.
7.7
7.7. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 7 POPQ assessment: Point C.
7.8
7.8. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 8 Stress urinary incontinence (4‐7 years).
7.9
7.9. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 9 Operating time (minutes).
7.10
7.10. Analysis
Comparison 7 Sacral colpopexy with continence surgery vs without, Outcome 10 Blood transfusion.
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References

References to studies included in this review

Anger 2014 {published data only}
    1. Anger JT, Mueller ER, Tarnay C, Smith B, Stroupe K, Rosenman A, et al. Robotic compared with laparoscopic sacrocolpopexy: a randomized controlled trial. Obstetrics and Gynecology 2014;123(1):5‐12. - PMC - PubMed
Barber 2014 {published data only}
    1. Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 2014;311(10):1023‐34. - PMC - PubMed
Benson 1996 {published and unpublished data}
    1. Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long‐term outcome evaluation. American Journal of Obstetrics and Gynecology 1996;175(6):1418‐22. [4815] - PubMed
Braun 2007 {published data only}
    1. Braun HF, Fernandez M, Dell'Oro A, Gonzalez F, Cuevas R, Rojas I. Prospective randomised study to compare colposacropexy and Mayo McCall technique in the correction of severe genital central prolapse (Abstract number 19). International Urogynecology Journal 2007;18 Suppl 1:12.
Brubaker 2008 {published data only}
    1. Brubaker L, Cundiff G, Fine P, Nygaard I, Richter H, Visco A, et al. A randomized trial of colpopexy and urinary reduction efforts (CARE): design and methods. Controlled Clinical Trials 2003;24(5):629‐42. - PubMed
    1. Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW, et al. Two‐year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence. Obstetrics and Gynecology 2008;112(1):49‐55. - PMC - PubMed
    1. McClure LA, Brown MB. A likelihood approach to analyzing clinical trial data when treatments favor different outcomes. Contemporary Clinical Trials 2006;27(4):340‐52. - PubMed
    1. Nygaard I, Brubaker L, Zyczynski H, Cundiff G, Ritcher H, Gantz M, et al. Long‐term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 2013;309(19):2016‐24. [clinical trials.gov: NCT00099372] - PMC - PubMed
    1. Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P, et al. Pelvic Floor Disorders Network. The role of preoperative urodynamic testing in stress‐continent women undergoing sacrocolpopexy. International Urogynecology Journal 2008;19(5):607‐14. - PMC - PubMed
Costantini 2007 {published data only}
    1. Costatini E, Zucchi A, Giannantoni A, Mearini L, Bini V, Porena M. Must colposuspension be associated with sacropexy to prevent postoperative urinary incontinence?. European Urology 2007;51:788‐94. - PubMed
Costantini 2008 {published data only}
    1. Costantini E, Lazzeri M, Bini V, Zingaro M, Zucchi A, Porena M. Burch colposuspension does not provide any additional benefit to pelvic organ prolapse repair in patients with urinary incontinence: a randomized surgical trial [see comment]. Journal of Urology 2008;180(3):1007‐12. - PubMed
    1. Costantini E, Lazzeri M, Bini V, Zingaro M, Zucchi A, Porena M. Pelvic organ prolapse repair with and without prophylactic concomitant Burch colposuspension in continent women: a randomized, controlled trial with 8‐year follow up. Journal of Urology 2011;185(6):2236‐40. - PubMed
    1. Costantini E, Zucchi A, Giannantoni A, Mearini L, Bini V, Porena M. Must colposuspension be associated with sacropexy to prevent postoperative urinary incontinence?. European Urology 2007;51(3):788‐94. - PubMed
Costantini 2013 {published data only}
    1. Costantini E, Pietropaolo A, Nunzi E, Bini V, Salvini E, Bruno R, et al. Prospective randomized trial comparing abdominal vs laparoscopic sacropexy for the treatment of advanced pelvic organ prolapse (Abstract number 61). Neurourology and Urodynamics 2013;32(S1):S55‐56.
Culligan 2005 {published data only}
    1. Culligan P, Blackwell L, Goldsmith J, Rogers A, Heit M. A double‐blind, randomized controlled trial comparing solvent‐dehydrated cadaveric fascia lata and polypropylene mesh for sacral colpopexy. Proceedings of the Joint Meeting of the International Continence Society (34th Annual Meeting) and the International Urogynecological Association, 2004 Aug 23‐27, Paris. 2004.
    1. Culligan PJ, Blackwell L, Goldsmith LJ, Graham CA, Rogers A, Heit MH. A randomized controlled trial comparing fascia lata and synthetic mesh for sacral colpopexy. Obstetrics and Gynecology 2005;106(1):29‐37. - PubMed
    1. Tate SB, Blackwell L, Lorenz DJ, Steptoe MM, Culligan PJ. Randomized trial of fascia lata and polypropylene mesh for abdominal sacrocolpopexy: 5‐year follow‐up. International Urogynecology Journal 2011;22(2):137‐43. - PubMed
Culligan 2013 {published data only}
    1. Culligan P, Salamon C, Priestley J, Shariati A. Porcine Dermis compared with polypropylene mesh for laparoscopic sacrocolpopexy. Obstetrics and Gynecology 2013;121:143‐51. - PubMed
da Silviera 2015 {published data only}
    1. Dos Reis Brandão da Silveira S, Haddad JM, Jármy‐Di Bella Z, Nastri F, Kawabata M, Silva Carramão S, et al. Multicenter, randomised trial comparing native vaginal tissue repair and synthetic mesh repair for genital prolapse surgical treatment. International Urogynecology Journal 2015;26(3):335‐42. - PubMed
de Tayrac 2008 {published data only}
    1. Tayrac R, Mathe ML, Bader G, Deffieux X, Fazel A, Fernandez H. Infracoccygeal sacropexy or sacrospinous suspension for uterine or vaginal vault prolapse. International Urogynecology Journal 2008;100(2):154‐9. - PubMed
Detollenaere 2015 {published data only}
    1. Detollenaere RJ, Boon J, Stekelenburg J, IntHout J, Vierhout ME, Kluivers KB, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non‐inferiority trial. BMJ May‐ June 2015;351(5‐6):E400‐6. - PMC - PubMed
    1. Detollenaere RJ, Boon J, Stekelenburg J, Kluivers KB, Vierhout ME, Vanijndhoven HW. Short term anatomical results of a randomized controlled non inferiority trial comparing sacrospinous hysteropexy and vaginal hysterectomy in treatment of uterine prolapse stage 2 or higher. International Urogynecology Journal 2013;24(1):S1.
Dietz 2010 {published data only}
    1. Dietz V, Schraffordt KS, Graaf Y, Heintz P, Vaart C. One‐year follow‐up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. International Urogynecology Journal 2010;21(2):209‐16. [39364] - PMC - PubMed
    1. Dietz V, Schraffordt KS, Graaf Y, Heintz P, Vaart C. Sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: A randomized study (Abstract number 92). International Urogynecology Journal 2008;19 Suppl 1:S94‐6. [29180] - PMC - PubMed
Freeman 2013 {published data only}
    1. Freeman RM, Pantazis K, Thomson A, Frapell J, Bombieri L, Moran P, et al. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post‐hysterectomy vaginal vault prolapse: LAS study. International Urogynecology Journal 2013; Vol. 24, issue 3:377‐84. [DOI: 10.1007/s00192-012-1885-x; 46279] - DOI - PubMed
    1. Pantazis K, Freeman R, Thomson A, Frappell J, Bombieri L, Moran P, et al. Open and laparoscopic sacrocolpopexy demonstrate clinical equivalence: one year results from the LAS Trial, an RCT comparing the two approaches for treating post hysterectomy vault prolapse (Abstract number 131). Neurourology and Urodynamics 2011;30(6):986‐7. [42187]
    1. Pantazis K, Freeman R, Thomson A, Frappell J, Bombieri L, Waterfield M. Results from the LAS trial, an RCT comparing open abdominal to laparoscopic sacrocolpopexy for the treatment of post hysterectomy vault prolapse (Abstract number 120). International Urogynecology Journal 2008;19 Suppl 1:101‐2. [29178]
Halaska 2012 {published data only}
    1. Halaska M, Maxova K, Sottner O, Svabik K, Mlcoch M, Kolarik D, et al. A multicentre randomized prospective controlled study comparing sacrospinous fixation and transvaginal mesh in the treatment of post hysterectomy vaginal vault prolapse. American Journal of Obstetrics and Gynecology 2012;207(301):e1‐7. - PubMed
Iglesia 2010 {published data only}
    1. Gutman R, Nosti P, Sokol A, Sokol E, Peterson J, Wang H, et al. Three‐year outcome of vaginal mesh for prolapse, A randomized controlled trial. Obstetrics and Gynecology 2013;122(4):770‐7. [Clinicaltrials.gov: NCT00475540] - PubMed
    1. Iglesia CB, Sokol AI, Sokol ER, Kudish BI. Vaginal mesh for prolapse: a randomized controlled trial. Obstetrics and Gynecology 2010;116(2 Pt 1):293‐303. [39891] - PubMed
    1. Sokol AI, Iglesia CB, Kudish BI, Gutman RE, Shveiky D, Bercik R, et al. One‐year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. American Journal of Obstetrics and Gynecology 2012;206(1):86.e1‐9. [DOI: 10.1016/j.ajog.2011.08.003; 42158] - DOI - PubMed
Jeng 2005 {published data only}
    1. Jeng CJ, Yang YC, Tzeng CR, Shen J, Wang LR. Sexual functioning after vaginal hysterectomy or transvaginal sacrospinous uterine suspension for uterine prolapse: a comparison. Journal of Reproductive Medicine 2005;50(9):669‐74. - PubMed
Lim 2012 {published data only}
    1. Lim, A. Rosamilia, P. L. Dwyer, J. Alvarez, F.Chao, C.Murray, A.Leitch, L.Schierlitz, A.Desouza, E. Thomas, G. Agnew, J. Lee. Randomised controlled trial of post‐ hysterectomy vaginal vault prolapse treatment with extraperitoneal vaginal uterosacral ligament suspension with anterior mesh reinforcement vs sacrocolpopexy (open/laparoscopic). International Urogynecology Journal 2012;23:S151.
Lo 1998 {published data only}
    1. Lo TS, Wang AC. Abdominal colposacropexy and sacrospinous ligament suspension for severe uterovaginal prolapse: A comparison. Journal of Gynecologic Surgery 1998;14(2):59‐64. [17553]
Maher 2004 {published and unpublished data}
    1. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: A prospective randomized study. American Journal of Obstetrics and Gynecology 2004;190(1):20‐6. - PubMed
Maher 2011 {published data only}
    1. Maher C, Connelly L. Cost minimization analysis of laparoscopic sacral colpopexy and total vaginal mesh. American Journal of Obstetrics and Gynecology 2012;206(5):1‐7. - PubMed
    1. Maher CF, Feiner B, Decuyper EM, Nichlos CJ, Hickey KV, O'Rourke P. Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. American Journal of Obstetrics and Gynecology 2011;204(4):e361‐7. [41344] - PubMed
Meschia 2004a {published and unpublished data}
    1. Meschia M, Gattei U, Pifarotti P, Spennacchio M, Longatti D, Barbacini P. Randomized comparison between infracoccygeal sacropexy (posterior IVS) and sacrospinous fixation in the management of vault prolapse (Abstract number 614). Proceedings of the Joint Meeting of the International Continence Society (34th Annual Meeting) and the International Urogynecological Association, 2004 Aug 23‐27, Paris. 2004.
Natale 2010 {published and unpublished data}
    1. Natale F, Mako A, Panei M, Weir J, Antomarchi F, Cervigni M. High levator myorraphy versus uterosacral ligament suspension for vaginal vault fixation: a prospective, randomized study. International Urogynecology Journal 2010;21(5):515‐22. - PubMed
Paraiso 2011 {published data only}
    1. Paraiso MF, Jelovsek JE, Frick A, Chen CC, Barber MD. Laparoscopic compared with robotic sacral colpopexy for vaginal prolapse. A randomised controlled trial. Obstetrics and Gynecology 2011;118(5):1005‐13. [42679] - PubMed
    1. Paraiso MFR, Jelovsek JE, Frick A, Chen CCG, Barber MD. Conventional laparoscopic versus robotic‐assisted laparoscopic sacral colpopexy: a randomized controlled trial (Abstract number 108). Neurourology and Urodynamics 2010;29(6):964‐5. [40137]
Rahmanou 2015 {published data only}
    1. Rahmanou P, Price N, Jackson SR. Laparoscopic hysteropexy versus vaginal hysterectomy for the treatment of uterovaginal prolapse: a prospective randomized pilot study. International Urogynecology Journal 2015;26(11):1687‐94. - PubMed
Rondini 2015 {published data only}
    1. Rondini C, Braun H, Alvarez J, Descouvieres C, Wenzel C, Aros S. Prospective‐randomized study comparing high uterosacral vault suspension vs. abdominal sacrocolpopexy for the repair of apical defects and vaginal vault prolapse (Abstract number 90). Neurourology and Urodynamics 2010;29(6):939. [40132]
    1. Rondini C, Braun H, Alvarez J, Urzúa MJ, Villegas R, Wenzel C, et al. High uterosacral vault suspension vs Sacrocolpopexy for treating apical defects: a randomized controlled trial with twelve months follow‐up. International Urogynecology Journal 2015;26(8):1131‐8. - PubMed
    1. Rondini C, Braun HF, Alvarez J, Urzua M, Villegas R, Escobar M, et al. Prospective‐randomised study comparing high uterosacral vault suspension vs abdominal sacral colpopexy for the correction of apical defects and vaginal vault prolapse (Abstract number: presentation 88). International Urogynecology Journal and Pelvic Floor Dysfunction 2011;22 Suppl 1:S87‐8. [42160]
    1. Rondini C, Urzua M, Braun H, Errazuriz J, Casteblanco V, Alvarez J, et al. Longterm prospective randomized study comparing high uterosacral vault suspension verus abdominal sacral colpopexy for the correction of apical defects and vaginal vault prolapse: four year follow up. International Urogynecology Journal 2013;24(004):S151‐2.
Roovers 2004 {published and unpublished data}
    1. Roovers J, Bleijenberg E, Schagen van Leeuwen J, Scholten P, Vaart H. Long term follow‐up of a randomized controlled trial comparing abdominal and vaginal surgical correction of uterine prolapse (Abstract number 88). International Urogynecology Journal 2008;19 Suppl 1:91‐2.
    1. Roovers JPWR, Bom JG, Vaart CH, Schagen van Leeuwen JH, Scholten PC, Heintz APM. A randomized comparison of post‐operative pain, quality of life, and physical performance during the first six weeks after abdominal or vaginal surgical correction of descensus uteri. Neurourology and Urodynamics 2005;24:334‐40. - PubMed
    1. Roovers JPWR, Vaart CH, Bom JG, Schagen van Leeuwen JH, Scholten PC, Heintz APM. A randomized controlled trial comparing abdominal and vaginal prolapse surgery of patients with descensus uteri grade II ‐ IV (Abstract). International Urogynecology Journal 2001;12 Suppl 3:S109. [16341]
    1. Roovers JPWR, Vaart CH, Bom JG, Leeuwen JHS, Scholten PC, Heintz APM. A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function. British Journal of Obstetrics and Gynaecology 2004;111(1):50‐6. - PubMed
Svabik 2014 {published data only}
    1. Svabik K, Martan A, Masata J, El‐Haddad R, Hubka P. Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial. Ultrasound in Obstetrics and Gynecology 4.2014;43(4):365‐71. - PubMed
Trabuco 2014 {unpublished data only}
    1. Trabuco. A randomized comparison of incontinence procedures performed concomitantly with abdominal sacral colpopexy; The Burch versus mid‐urethral sling trial. International Urogynecology Journal July 22–26, 2014; Vol. 25, issue PP01:S1‐2.

References to studies excluded from this review

Altman 2013 {published data only}
    1. Altman D, Mooller Bek K, Mikkola T, Gunnarsson J, Ellstrom Engh M, Falconer C. Intra‐and perioperative morbidity following pelvic organ prolapse repair using a transvaginal suture capturing mesh device compared to trocar guided transvaginal mesh and traditional colporraphy (Abstract number 251). Neurourology and Urodynamics 2013;32(6):873‐4.
Balci 2011 {published data only}
    1. Balci O, Capar M, Acar A, Colakoglu MC. Balci technique for suspending vaginal vault at vaginal hysterectomy with reduced risk of vaginal vault prolapse. Journal of Obstetrics and Gynaecology Research 2011;37(7):762‐9. - PubMed
Chao 2012 {published data only}
    1. Chao FL, Rosamilia A, Dwyer PL, Polyakov A, Schierlitz L, Agnew G. Does pre‐operative traction on the cervix approximate intra‐operative uterine prolapse? A randomised controlled trial. International Urogynecology Journal 2012;23(4):417‐22. - PubMed
Heinonen 2011 {published data only}
    1. Heinonen PK, Nieminen K. Combined anterior vaginal wall mesh with sacrospinous ligament fixation or with posterior intravaginal slingplasty for uterovaginal or vaginal vault prolapse. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2011;157(2):230‐3. - PubMed
Juneja 2010 {published data only}
    1. Juneja M, Munday D, Kopetz V, Barry C. Hysterectomy vs no hysterectomy for uterine prolapse in conjunction with posterior infracococcygeal colpopexy ‐ a randomised pilot study 12 months review (Abstract number 692). Proceedings of the Joint Meeting of the International Continence Society (ICS) and the International Urogynecological Association, 2010 Aug 23‐27, Toronto, Canada. 2010.

References to ongoing studies

Cortesse 2010 {published data only}
    1. Cortesse A. Evaluating the necessity of TOT implantation in women with pelvic organ prolapse and occult stress urinary incontinence (ATHENA). www.ClinicalTrials.gov [accessed 19 April 2011] 2011:clinicaltrials.gov/ct2/show/NCT01095692. [41350]
Glazener 2009 {published data only}
    1. Glazener CMA. Clinical and cost‐effectiveness of surgical options for the management of anterior and/or posterior vaginal wall prolapse: two randomised controlled trials within a comprehensive cohort study (PROSPECT). www.controlled‐trials.com/ISRCTN60695184 (accessed 13 April 2010) 2009. - PubMed
van der Steen 2010 {published data only}
    1. Roovers JPWR, Ploeg M. Concomitant surgery and Urodynamic investigation in genital Prolapse and stress Incontinence. A Diagnostic study including Outcome evaluation. CUPIDO 1: Vaginal prolapse repair and mid urethral sling procedure in women with genital prolapse and predominant stress urinary incontinence. Netherlands Trial Register. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1197 2009. [34193]
    1. Steen A, Ploeg M, Dijkgraaf MG, V, Roovers JP. Protocol for the CUPIDO trials; multicenter randomized controlled trials to assess the value of combining prolapse surgery and incontinence surgery in patients with genital prolapse and evident stress incontinence (CUPIDO I) and in patients with genital prolapse and occult stress incontinence (CUPIDO II). BMC Women's Health 2010;10:16. [39877] - PMC - PubMed
Verleyen 2004 {published data only}
    1. Verleyen P, Filip C, Bart K, Frank VDA, Jan D, Dirk DR. A prospective randomised trial comparing Pelvicol (trademark) and Vicryl (trademark) for cystocoele repair in the Raz‐colposuspension (Abstract number 613). Proceedings of the International Continence Society (34th Annual Meeting) and the International Urogynecological Association; 2004 Aug 23‐27; Paris. 2004.

Additional references

Adams 2004
    1. Adams E, Thomson A, Maher C, Hagen S. Mechanical devices for pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2004, Issue 2. [DOI: 10.1002/14651858.CD004010.pub2] - DOI - PubMed
Barber 2013
    1. Barber MD, Maher C. Apical prolapse. International Urogynecology Journal 2013;24(11):1815‐33. - PubMed
Brubaker 2002
    1. Brubaker L, Bump R, Jacquetin B, Schuessler B, Weidner A, Zimmern P, et al. Pelvic organ prolapse. Incontinence: 2nd International Consultation on Incontinence. 2nd Edition. Plymouth: Health Publication Ltd, 2002:243‐65.
Brubaker 2009
    1. Brubaker L, Glazener C, Jacquetin B, Maher C, Melgrem A, Norton P, Rajamaheshwari N, Theobald P. Surgery for Pelvic Organ Prolapse. 4th International Consultation on Incontinence.edited by P. Abrams, L. Cordozo, S. Koury and A. Wein Paris 2009;Chapter 15:1278.
Bugge 2013
    1. Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapse in women.. Cochrane Database of Systematic Reviews 2013, (2). [DOI: 10.1002/14651858.CD004010.pub3] - DOI - PMC - PubMed
Cohen 1988
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd Edition. Lawrence Erlbaum Associates, 1988.
Costantini 2011
    1. Costantini E, Lazzeri M, Bini V, Zingaro M, Zucchi A, Porena M. Pelvic organ prolapse repair with and without prophylactic concomitant Burch colposuspension in continent women: a randomized, controlled trial with 8‐year follow up. Journal of Urology 2011;185(6):2236‐40. - PubMed
FDA 2011
    1. Food, Drug Administration (FDA). Surgical mesh for POP and SUI Repair: FDA Executive Summary. www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Medi... 23 August 2011.
Gutman 2013
    1. Gutman R, Nosti P, Sokol A, Sokol E, Peterson J, Wang H, et al. Three‐year outcome of vaginal mesh for prolapse, a randomized controlled trial. Obstetrics and Gynecology 2013;122(4):770‐7. [Clinicaltrials.gov: NCT00475540] - PubMed
Hagen 2011
    1. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2011, Issue 12. [DOI: 10.1002/14651858.CD003882.pub4] - DOI - PubMed
Handa 2004
    1. Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. American Journal of Obstetrics and Gynecology 2004;190(1):27‐32. - PubMed
Hendrix 2002
    1. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity. American Journal of Obstetrics and Gynecology 2002;186(6):1160‐6. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Available from www.cochrane‐handbook.org: The Cochrane Collaboration, 2011.
Hsu 2008
    1. Hsu Y, Chen L, Summers A, Ashton‐Miller JA, DeLancey JO. Anterior vaginal wall length and degree of anterior compartment prolapse seen on dynamic MRI. International Urogynecology Journal 2008;19(1):137‐42. - PMC - PubMed
Nygaard 2013
    1. Nygaard I, Brubaker L, Zyczynski H, Cundiff G, Ritcher H, Gantz M, et al. Long‐term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA 2013;309(19):2016‐24. [clinical trials.gov: NCT00099372] - PMC - PubMed
Siddiqui 2015
    1. Siddiqui NY, Grimes CL, Casiano ER, Abed HT, Jeppson PC, Olivera CK, et al. Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta‐analysis. Obstetrics and Gynecology 2015;125(1):44‐55. - PMC - PubMed

References to other published versions of this review

Maher 2004
    1. Maher C, Baessler K, Glazener CMA, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD004014.pub2] - DOI - PubMed

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