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Meta-Analysis
. 2018 Aug 19;8(8):CD013108.
doi: 10.1002/14651858.CD013108.

Surgery for women with pelvic organ prolapse with or without stress urinary incontinence

Kaven Baessler  1 , Corina Christmann-Schmid, Christopher Maher, Nir Haya, Tineke J Crawford, Julie Brown
Affiliations
Meta-Analysis

Surgery for women with pelvic organ prolapse with or without stress urinary incontinence

Kaven Baessler et al. Cochrane Database Syst Rev. .

Abstract

Background: Pelvic organ prolapse (POP) is common in women and is frequently associated with stress urinary incontinence (SUI). In many cases however, SUI is present only with the prolapse reduced (occult SUI) or may develop after surgical treatment for prolapse (de novo SUI).

Objectives: To determine the impact on postoperative bladder function of surgery for symptomatic pelvic organ prolapse with or without concomitant or delayed two-stage continence procedures to treat or prevent stress urinary incontinence.

Search methods: We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE-In-Process, ClinicalTrials.gov, WHO ICTRP, handsearching journals and conference proceedings (searched 11 November 2017) and reference lists of relevant articles. We also contacted researchers in the field.

Selection criteria: Randomised controlled trials (RCTs) including surgical operations for POP with or without continence procedures in continent or incontinent women. Our primary outcome was subjective postoperative SUI. Secondary outcomes included recurrent POP on examination, overactive bladder (OAB) symptoms, and voiding dysfunction.

Data collection and analysis: We used standard methodological procedures as expected by Cochrane.

Main results: We included 19 RCTs (2717 women). The quality of the evidence ranged from low to moderate. The main limitations were risk of bias (especially blinding of outcome assessors), indirectness and imprecision associated with low event rates and small samples.POP surgery in women with SUIVaginal repair with vs without concomitant mid-urethral sling (MUS)A concomitant MUS probably improves postoperative rates of subjective SUI, as the evaluated clinical effect appears large (risk ratio (RR) 0.30, 95% confidence interval (CI) 0.19 to 0.48; 319 participants, two studies; I² = 28%; moderate-quality evidence), and probably decreases the need for further continence surgery (RR 0.04, 95% CI 0.00 to 0.74; 134 participants, one study; moderate-quality evidence). This suggests that if the risk of SUI with POP surgery alone is 39%, the risk with an MUS is between 8% and 19%.Rates of recurrent POP on examination, OAB, and voiding dysfunction were not reported.Vaginal repair with concomitant vs delayed MUSEvidence suggested little or no difference between groups in reporting postoperative SUI (RR 0.41, 95% CI 0.12 to 1.37; 140 participants, one study; moderate-quality evidence).Rates of recurrent POP on examination, OAB, and voiding dysfunction and the need for further surgery were not reported.Abdominal sacrocolpopexy with vs without Burch colposuspensionAn additional Burch colposuspension probably has little or no effect on postoperative SUI at one year (RR 1.38, 95% CI 0.74 to 2.60; 47 participants, one study; moderate-quality evidence), OAB symptoms (RR 0.85, 95% CI 0.61 to 1.18; 33 participants, one study; moderate-quality evidence), or voiding dysfunction (RR 0.96, 95% CI 0.06 to 14.43; 47 participants, one study; moderate-quality evidence). Rates of recurrent POP and the need for further surgery were not reported.POP surgery in women with occult SUIVaginal repair with vs without concomitant MUSMUS probably improves rates of subjective postoperative SUI (RR 0.38, 95% CI 0.26 to 0.55; 369 participants, five studies; I² = 44%; moderate-quality evidence). This suggests that if the risk with surgery alone is 34%, the risk with a concomitant MUS is between 10% and 22%. Evidence suggests little or no difference between groups in rates of recurrent POP (RR 0.86, 95% CI 0.34 to 2.19; 50 participants, one study; moderate-quality evidence), OAB symptoms (RR 0.75, 95% CI 0.52 to 1.07; 43 participants, one study; low-quality evidence), or voiding dysfunction (RR 1.00, 95% CI 0.15 to 6.55; 50 participants, one study; low-quality evidence). The need for further surgery was not reported.POP surgery in continent women Vaginal repair with vs without concomitant MUSResearchers provided no conclusive evidence of a difference between groups in rates of subjective postoperative SUI (RR 0.69, 95% CI 0.47 to 1.00; 220 participants, one study; moderate-quality evidence). This suggests that if the risk with surgery alone is 40%, the risk with a concomitant MUS is between 19% and 40%. Rates of recurrent POP, OAB, and voiding dysfunction and the need for further surgery were not reported.Abdominal sacrocolpopexy with vs without Burch colposuspensionWe are uncertain whether there is a difference between groups in rates of subjective postoperative SUI (RR 1.31, 95% CI 0.19 to 9.01; 379 participants, two studies; I² = 90%; low-quality evidence), as RCTs produced results in different directions with a very wide confidence interval. We are also uncertain whether there is a difference between groups in rates of voiding dysfunction (RR 8.49, 95% CI 0.48 to 151.59; 66 participants, one study; low-quality evidence) or recurrent POP (RR 0.98, 95% CI 0.74 to 1.30; 250 participants, one study; moderate-quality evidence. No study reported OAB symptoms and need for further surgery.Vaginal repair with armed anterior vaginal mesh repair vs anterior native tissue Anterior armed mesh repair may slightly increase postoperative de novo SUI (RR 1.58, 95% CI 1.05 to 2.37; 905 participants, seven studies; I² = 0%; low-quality evidence) but may decrease recurrent POP (RR 0.29, 95% CI 0.22 to 0.38; 848 participants, five studies; I² = 0%; low-quality evidence). There may be little or no difference in rates of voiding dysfunction (RR 1.65, 95% CI 0.22 to 12.10; 125 participants, two studies; I² = 0%; low-quality evidence). Rates of OAB and the need for further surgery were not reported.Adverse events were infrequently reported in all studies; cost was not studied in any trial.

Authors' conclusions: In women with POP and SUI (symptomatic or occult), a concurrent MUS probably reduces postoperative SUI and should be discussed in counselling. It might be feasible to postpone the MUS and perform a delayed (two-stage) continence procedure, if required.Although an abdominal continence procedure (Burch colposuspension) during abdominal POP surgery in continent women reduced de novo SUI rates in one underpowered trial, another RCT reported conflicting results. Adding an MUS during vaginal POP repair might reduce postoperative development of SUI.An anterior native tissue repair might be better than use of transobturator mesh for preventing postoperative SUI; however, prolapse recurrence is more common with native tissue repair.

PubMed Disclaimer

Conflict of interest statement

KB, JB, CC, TC, NH, and CM have no conflicts of interest to declare.

Figures

1
1
Decision pathway pelvic organ prolapse surgery ‐ published with permission of Wolters Kluwer. Maher CF, Baessler KK, Barber MD, Cheon C, Consten ECJ, Cooper KG, et al. Summary: 2017 International Consultation on Incontinence Evidence‐Based Surgical Pathway for Pelvic Organ Prolapse. Female Pelvic Medicine & Reconstructive Surgery 2018 April 28 [Epub ahead of print]. https://insights.ovid.com/pubmed?pmid=29727373. (Maher 2018)
2
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PRISMA study flow diagram.
3
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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Forest plot of comparison: 1 Comparisons of surgery in women with POP and SUI, outcome: 1.1 Vaginal POP surgery with vs without concomitant continence surgery: additional MUS vs vaginal repair alone.
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Forest plot of comparison: 1 Comparisons of surgery in women with POP and SUI, outcome: 1.2 Vaginal POP surgery with concomitant vs delayed continence surgery: additional concomitant MUS vs delayed MUS.
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Forest plot of comparison: 1 Comparisons of surgery in women with POP and SUI, outcome: 1.3 Abdominal POP surgery with vs without concomitant continence surgery: additional Burch colpo vs sacrocolpopexy alone.
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Forest plot of comparison: 1 Comparisons of surgery in women with POP and SUI, outcome: 1.4 Abdominal POP surgery with different concomitant continence procedures: additional MUS vs Burch colpo at sacral colpopexy.
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Forest plot of comparison: 1 Comparisons of surgery in women with POP and SUI, outcome: 1.5 Abdominal continence surgery vs vaginal POP surgery: Burch colpo vs anterior repair.
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Forest plot of comparison: 2 Comparisons of surgery in women with POP and occult SUI, outcome: 2.1 Vaginal POP surgery with or without concomitant continence surgery: additional MUS vs vaginal repair alone.
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Forest plot of comparison: 3 Comparisons of surgery in continent women with POP, outcome: 3.1 Vaginal POP surgery with or without concomitant continence surgery: additional MUS vs vaginal repair alone.
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Forest plot of comparison: 3 Comparisons of surgery in continent women with POP, outcome: 3.2 Abdominal POP surgery with or without concomitant continence surgery: additional Burch colpo vs sacral colpopexy alone.
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Forest plot of comparison: 3 Comparisons of surgery in continent women with POP, outcome: 3.3 Additional Burch colpo vs sacrocolpopexy alone: QoL data.
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Forest plot of comparison: 3 Comparisons of surgery in continent women with POP, outcome: 3.4 One type of POP surgery vs another: armed anterior mesh vs anterior native repair.
See this image and copyright information in PMC

References

References to studies included in this review

Altman 2011 {published data only}
    1. Altman D, Väyrynen T, Engh ME, Axelsen S, Falconer C, for the Nordic Transvaginal Mesh Group. Anterior colporrhaphy versus transvaginal mesh for pelvic‐organ prolapse. New England Journal of Medicine 2011;364(19):1826‐36. [41463] - PubMed
    1. Ek M, Altman D, Elmér C, Gunnarsson J, Falconer C, Tegerstedt G. Clinical efficacy of a trocar guided mesh kit for the repair of anterior lateral defects (Abstract number 556). 41st Annual Meeting of the International Continence Society (ICS), 2011 Aug 29 to Sept 2, Glasgow, Scotland. 2011, issue 2011. [CRSREF: 3226049]. [Abstract number 556]
    1. Ek M, Tegerstedt G, Falconer C, Kjaeldgaard A, Rezapour M, Rudnicki M, et al. Urodynamic assessment of anterior vaginal wall surgery: a randomized comparison between colporrhaphy and transvaginal mesh. Neurourology and Urodynamics 2010;29:527‐31. [39589] - PubMed
Borstad 2010 {published data only}
    1. Borstad E, Abdelnoor M, Mogimi K, Sandved M, Majida M, Western K, et al. Surgery for concomitant pelvic organ prolapse and urinary stress incontinence. A multicenter prospective randomized trial to compare the results of an incontinence procedure performed at the time of prolapse repair or 3 months after (Abstract number 120). Neurourology and Urodynamics 2008;27(7):713. [29653]
    1. Borstad E, Abdelnoor M, Staff AC, Kulseng‐Hanssen S. Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. International Urogynecology Journal and Pelvic Floor Dysfunction 2010;21(2):179‐86. [39362] - PubMed
    1. Borstad E, Kulseng‐Hanssen S, Moghimi K, Sandved M, Majida M, Western K, et al. An incontinence procedure performed at the time of prolapse repair might be unnecessary surgery (Abstract number 35). Neurourology and Urodynamics 2006;25(6):551‐2. [26618]
Brubaker 2006 {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, Cundiff G, Fine P, Nygaard I, Richter H, Visco A, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. New England Journal of Medicine 2006;354(15):1557‐66. - 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. 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
Colombo 2000 {published data only}
    1. Colombo M, Vitobello D, Proietti F, Milani R. Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse. British Journal of Obstetrics and Gynaecology 2000;107(4):544‐51. - PubMed
Costantini 2007 {published data only}
    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 2008 {published data only}
    1. Costantini E, Lazzeri M, Bini V, Zingaro M, Frumenzio E, Porena M. Pelvic organ prolapse repair with and without concomitant Burch colposuspension in incontinent women: a randomised controlled trial with at least 5‐year followup. Obstetrics and Gynecology International 2012;2012:967923. [DOI: 10.1155/2012/967923] - DOI - PMC - PubMed
    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
Fuentes 2011 {published data only}
    1. Fuentes AE. A prospective randomised controlled trial comparing vaginal prolapse repair with and without tension‐free vaginal tape transobturator tape (TVTO) in women with severe genital prolapse and occult stress incontinence: long term follow up. International Urogynecology Journal 2011;22(Suppl 1)(Abstract 059):S60‐1.
Hiltunen 2007 {published data only}
    1. Hiltunen R, Nieminen K, Takala T, Heiskanen E, Merikari M, Niemi K, et al. Low‐weight polypropylene mesh for anterior vaginal wall prolapse: a randomized controlled trial. Obstetrics and Gynecology 2007;110(2 pt 2):455‐62. - PubMed
    1. Nieminen K, Hiltunen R, Heiskanen E, Takala T, Niemi K, Merikari M, et al. Symptom resolution and sexual function after anterior vaginal wall repair with or without polypropylene mesh. International Urogynecology Journal. 2008;19(12):1611‐6. - PubMed
    1. Nieminen K, Hiltunen R, Takala T, Heiskanen E, Merikari M, Niemi K, et al. Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow‐up. American Journal of Obstetrics and Gynecology 2010;203(3):235.e1‐8. [40020] - PubMed
Iglesia 2010 {published data only}
    1. Gutman RE, Nosti PA, Sokol AI, Sokol ER, Peterson JL, Wang H, Iglesia CB. Three‐year outcomes of vaginal mesh for prolapse: a randomized controlled trial. Obstetrics & Gynecology 2013;122(4):770‐77. - PubMed
    1. Iglesia CB, Sokol AI, Sokol ER, Kudish BI. Vaginal mesh for prolapse: a randomized controlled trial. Obstetrics & 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
Meschia 2004 {published data only}
    1. Meschia M, Buonaguidi A, Amicarelli F, Pifarotti P, Gattei U, Stoppelli S. A randomized prospective comparison of TVT and endopelvic fascia plication in the treatment of occult stress urinary incontinence in patients with severe genital prolapse (Abstract). International Urogynecology Journal and Pelvic Floor Dysfunction 2001;12 Suppl 3:10. [15457]
    1. Meschia M, Pifarotti P, Gattei U, Ronchetti A, Stoppelli S, Lampugnani F. TVT and prolapse repair for treatment of occult stress urinary incontinence. International Continence Society (ICS) 32nd Annual Meeting; 2002 Aug 28‐30; Heidelberg, Germany. 2002:198‐9. [299]
    1. Meschia M, Pifarotti P, Spennacchio M, Buonaguidi A, Gattei U, Somigliana E. A randomized comparison of tension‐free vaginal tape and endopelvic fascia plication in women with genital prolapse and occult stress urinary incontinence. American Journal of Obstetrics and Gynecology 2004;190(3):609‐13. [17213] - PubMed
    1. Meschia M, Spennacchio F, Amicarelli P, Pifarotti P, Cavoretto S, Stoppelli S. A randomized prospective comparison of TVT and endopelvic fascia plication in the treatment of occult stress urinary incontinence in patients with genital prolapse: preliminary data. Neurourology and Urodynamics 2001;20(4):423‐4.
Rudnicki 2014 {published data only}
    1. Rudnicki M, Laurikainen E, Pogosean R, Kinne I, Jakobsson U, Teleman P. A 3‐year follow‐up after anterior colporrhaphy compared with collagen‐coated transvaginal mesh for anterior vaginal wall prolapse: a randomised controlled trial. British Journal of Obstetrics and Gynaecology 2016;123(1):136‐42. - PubMed
    1. Rudnicki M, Laurikainen E, Pogosean R, Kinne I, Jakobsson U, Teleman P. Anterior colporrhaphy compared with collagen‐coated transvaginal mesh for anterior vaginal wall prolapse: a randomised controlled trial. British Journal of Obstetrics and Gynaecology 2014;121(1):102‐10. - PubMed
Schierlitz 2014 {published data only}
    1. Schierlitz L, Dwyer P, Rosamilia A, Souza A, Murray C, Thomas E, et al. Pelvic organ prolapse surgery with and without tension‐free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: a randomised controlled trial. International Urogynecology Journal 2014;25:33‐40. - PubMed
    1. Walsh CE, Dwyer PL, Rosamilia A, Murray C, Thomas EA, Hiscock R, et al. A randomised controlled trial comparing pelvic organ prolapse surgery with and without tension‐free vaginal tape in women with occult or asymptomatic urodynamic stress incontinence: 6 year follow‐up. International Urogynecology Journal and Pelvic Floor Dysfunction 2016;27(1 Suppl 1):S57‐8. - PubMed
Sivaslioglu 2008 {published data only}
    1. Sivaslioglu AA, Unlubilgin E, Dolen I. A randomized comparison of polypropylene mesh surgery with site‐specific surgery in the treatment of cystocoele. International Urogynecology Journal. 2008;19(4):467‐71. - PubMed
Trabuco 2014 {unpublished data only}
    1. Trabuco EC, Klingele CJ, Blandon R, Occhino JA, McGree ME, Weaver AL, et al. A randomized comparison of incontinence procedures performed concomitantly with abdominal sacral colpopexy: the Burch versus mid‐urethral sling trial. International Urogynecology Journal 2014;25(Suppl 1):S1‐2.
    1. Trabuco EC, Klingele CJ, Occhino J, Blandon RE, McGree ME, Weaver A, et al. Treatment success of Burch and midurethral sling 2 years following combined procedure with sacrocolpopexy. International Urogynecology Journal and Pelvic Floor Dysfunction 2016;27(1 Suppl):S46.
Turgal 2013 {published data only}
    1. Turgal M, Sivaslioglu A, Yildiz A, Dolen I. Anatomical and functional assessment of anterior colporrhaphy versus polypropylene mesh surgery in cystocele treatment. European Journal of Obstetrics and Gynecology and Reproductive Biology 2013;170(2):555‐8. - PubMed
van der Ploeg 2015 (CUPIDO I) {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. Ploeg J, Rengerink K, Steen A, Leeuwen H, Stekelenburg J, Bongers M, et al. on behalf of the Dutch Urogynaecology Consortium. Transvaginal prolapse repair with or without the addition of a midurethral sling in women with genital prolapse and stress urinary incontinence: a randomised trial. British Journal of Obstetrics & Gynaecology 2015;122:1022‐30. - PubMed
    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
van der Ploeg 2016 (CUPIDO II) {published data only}
    1. Ploeg J, Rengerink K, Steen A, Leeuwen H, Haart C, Roovers JP, on behalf of the Dutch Urogynaecology Consortium. Vaginal prolapse repair with or without a midurethral sling in women with genital prolapse and occult stress urinary incontinence: a randomized trial. International Urogynecology Journal 2016;27(7):1029‐38. - PubMed
    1. Steen A, Ploeg M, Dijkgraaf MG, Vaart H, 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
Wei 2011 {published data only}
    1. Kenton K. The value of the preoperative prolapse reduction stress test in women without stress incontinence symptoms undergoing vaginal prolapse surgery with or without a TVT: result from the OPUS trial (Abstract 50). Neurourology and Urodynamics 2011;30(6):870‐1. [42171]
    1. Wei J. A mid urethral sling prevents incontinence among women undergoing vaginal prolapse repair ‐ the OPUS trial (Abstract number 5). Neurourology and Urodynamics 2011;30(6):809‐10. [42165]
    1. Wei J, Nygaard I, Richter H, Brown M, Barber M, Xiao Xu, et al. Outcomes following vaginal prolapse repair and mid urethral sling (OPUS) trial ‐ design and methods. Clinical Trials 2009;6(2):162‐71. [31120] - PMC - PubMed
    1. Wei J, Nygaard I, Richter H, Nager C, Barber MD, Kenton K. A midurethral sling to reduce incontinence after vaginal prolapse repair. New England Journal of Medicine 2012;366(25):2358‐67. [45050] - PMC - PubMed
Withagen 2011 {published and unpublished data}
    1. Milani AL, Withagen MI, The HS, Nedelcu‐Van der Wijk I, Vierhout ME. Sexual function following trocar‐guided mesh or vaginal native tissue repair in recurrent prolapse: a randomized controlled trial. Journal of Sexual Medicine 2011;8(10):2944‐53. [42064] - PubMed
    1. Withagen MI, Milani AL, Boon Den J, Vervest HA, Vierhout ME. Tension free vaginal mesh compared to conventional vaginal prolapse surgery in recurrent prolapse; a randomized controlled trial (Abstract number 090). International Urogynaecology Journal 2009;20 Suppl 2:S153‐4. [39885]
    1. Withagen MI, Milani AL, Boon J, Vervest HA, Vierhout ME. Trocar‐guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstetrics and Gynecology 2011;117(2 Pt 1):242‐50. [40881] - PubMed

References to studies excluded from this review

Allahdin 2008 {published data only}
    1. Allahdin S, Glazener C, Bain C. A randomised controlled trial evaluating the use of polyglactin mesh, polydioxanone and polyglactin sutures for pelvic organ prolapse surgery. Journal of Obstetrics and Gynaecology 2008;28(4):427‐31. - PubMed
    1. Madhuvrata P, Glazener C, Boachie C, Allahdin S, Bain C. A randomised controlled trial evaluating the use of polyglactin (Vicryl) mesh, polydioxanone (PDS) or polyglactin (Vicryl) sutures for pelvic organ prolapse surgery: outcomes at 2 years. Journal of Obstetrics and Gynaecology 2011;31(5):429‐35. - PubMed
Barber 2006 {published data only}
    1. Barber MD, Walters MD, Cundiff GW, PESSRI Trial Group. Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women undergoing vaginal surgery and pessary treatment for pelvic organ prolapse. American Journal of Obstetrics and Gynecology 2006;194(5):1492‐8. - PubMed
Bergman 1989 {published data only}
    1. Bergman A, Koonings PP, Ballard CA. Primary stress urinary incontinence and pelvic relaxation. American Journal of Obstetrics and Gynecology 1989;161(1):97‐101. - PubMed
Biller 2008 {published data only}
    1. Biller DH, Guerette NL, Bena JF, Davila GW. A prospective, randomized controlled trial of the use of an anal purse‐string suture to decrease contamination during pelvic reconstructive surgery. International Urogynecology Journal. 2008;19(1):59‐63. - PubMed
Boccasanta 2004 {published data only}
    1. Boccasanta P, Venturi M, Salamina G, Cesana BM, Bernasconi F, Roviaro G. New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial. International Journal of Colorectal Disease 2004;19:359‐69. - PubMed
Carramao 2008a {published data only}
    1. Carramao S, Auge AP, Pacetta AM, Duarte E, Ayrosa P, Lemos NL, et al. A randomized comparison of two vaginal procedures for the treatment of uterine prolapse using polypropylene mesh: hysteropexy versus hysterectomy. Revista do Colegio Brasileiro de Cirurgioes 2009;36(1):65‐72. - PubMed
    1. Carramao S, Lopes E, Auge A, Lemos N, Lunardelli J, Aoki T. A randomized comparison of two vaginal surgery for pelvic organ prolapse: hysterectomy with vaginal sacrospinous ligament fixation versus hysteropexy with repair of pelvic floor using mesh (Abstract number 93). International Urogynecology Journal 2008;19(Suppl 1):96.
Choe 2000 {published data only}
    1. Choe JM, Ogan K, Battino B. Antimicrobial mesh versus vaginal wall sling: a comparative outcomes analysis. Journal of Urology 2000;163(6):1829‐34. - PubMed
Colombo 1996b {published data only}
    1. Colombo M, Milani R, Vitobello D, Maggioni A. A randomized comparison of Burch colposuspension and abdominal paravaginal defect repair for female stress urinary incontinence. American Journal of Obstetrics and Gynecology 1996;175(1):78‐84. - PubMed
Cruikshank 1999 {published data only}
    1. Cruikshank SH, Kovac SR. Randomized comparison of three surgical methods used at the time of vaginal hysterectomy to prevent posterior enterocele. American Journal of Obstetrics and Gynecology 1999;180(4):859‐65. - PubMed
Debodinance 1993 {published data only}
    1. Debodinance P. Comparison of the Bologna and Ingelman‐Sundberg procedures for stress incontinence associated with genital prolapse: ten‐year follow‐up of a prospective randomized study. Journal de Gynecologie Obstetrique et Biologie de la Reproduction 2000;29(2):148‐53. - PubMed
    1. Debodinance P, Querleu D. Comparison of the Bologna and Ingelman‐Sundberg procedures for stress incontinence associated with genital prolapse: prospective randomized study. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1993;52(1):35‐40. - PubMed
Del Roy 2010 {published data only}
    1. Roy C. A randomized controlled trial study, to compare colporrhaphy versus NAZCA TC™, Macroporous polypropylene mesh, in surgical treatment to greater anterior vaginal prolapse. Joint Meeting of the International Continence Society (ICS) and the International Urogynecological Association; 2010 Aug 23‐27, Toronto, Canada. 2010. [Abstract number 667]
Di Palumbo 2003 {published data only}
    1. Palumbo VS. Four‐corner bladder and urethral retropubic suspension versus anterior colporrhaphy in the correction of stress urinary incontinence and urethrocystocele 3‐4. Randomized clinical trial. Urogynaecologia International Journal 2003;17(2):57‐68.
Duggan 2010 {published data only}
    1. Duggan P, Barry C. Anterior compartment prolapse: short term results and quality of life in women randomised to mesh or traditional repair. Joint Meeting of the International Continence Society (ICS) and the International Urogynecological Association; 2010 Aug 23‐27, Toronto, Canada. 2010. [Abstract number 687]
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), 2009. www.controlled‐trials.com/ISRCTN60695184 (accessed 13 April 2010). - PubMed
Hviid 2010 {published data only}
    1. Hviid U, Hviid TV, Rudnicki M. Porcine skin collagen implants for anterior vaginal wall prolapse: a randomised prospective controlled study. International Urogynecology Journal 2010;21(5):529‐34. [39449] - PubMed
Lamblin 2014 {published data only}
    1. Lamblin G, Van‐Nieuwenhuyse A, Chabert P, Lebail‐Carval K, Moret S, Mellier G. A randomized controlled trial comparing anatomical and functional outcome between vaginal colposuspension and transvaginal mesh. International Urogynecology Journal 2014;25:961–70. [DOI: 10.1007/s00192-014-2344-7] - DOI - PubMed
Lundarelli 2009 {published data only}
    1. Lunardelli JL, Auge AP, Lemos NL, Silva Carramao S, Oliveira AL, Duarte E, et al. Polypropylene mesh vs. Site‐specific repair in the treatment of anterior vaginal wall prolapse: preliminary results of a randomized clinical trial. Revista do Colegio Brasileiro de Cirurgioes 2009;36(3):210‐6. - PubMed
Menefee 2011 {published data only}
    1. Dyer K, Nguyen J, Lukacz E, Simsiman A, Luber K, Menefee S. The Optimal Anterior Repair Study (OARS): a triple arm randomized double blinded clinical trial of standard colporrhaphy, porcine dermis or polypropylene mesh augmented anterior vaginal wall repair (Abstract number 252). Neurourology and Urodynamics 2009;28(7):894‐5. [39346]
    1. Dyer K, Nguyen J, Simsiman A, Lukacz E, Luber K, Menefee S. The Optimal Anterior Repair Study (OARS): a triple arm randomized double blinded clinical trial of standard colporrhaphy versus vaginal paravaginal repair with porcine dermis graft or polypropylene mesh (Abstract number 281). Neurourology and Urodynamics 2010;29(6):1207‐8. [40164]
    1. Menefee SA, Dyer KY, Lukacz ES, Simsiman AJ, Luber KM, Nguyen JN. Colporrhaphy compared with mesh or graft‐reinforced vaginal paravaginal repair for anterior vaginal wall prolapse: a randomized controlled trial. Obstetrics and Gynecology 2011;118(6):1337‐44. [42866] - PubMed
Minassian 2014 {published data only}
    1. Minassian VA, Parekh M, Poplawsky D, Gorman J, Litzy L. Randomized controlled trial comparing two procedures for anterior vaginal wall prolapse. Neurourology and Urodynamics 2014; Vol. 33, issue 1:72‐7. [DOI: 10.1002/nau.22396] - DOI - PubMed
Natale 2009 {published data only}
    1. Cervigni M, Natale F, Weir J, Galante L, Panei M, Agostini M, et al. Prospective randomized trial of two new materials for the correction of anterior compartment prolapse: Pelvicol and Prolene Soft (Abstract). Neurourology and Urodynamics 2005;24(5/6):585‐6.
    1. Natale F, Penna C, Padoa A, Agostini M, Simone E, Cervigni M. A prospective, randomized, controlled study comparing Gynemesh(R), a synthetic mesh, and Pelvicol(R), a biologic graft, in the surgical treatment of recurrent cystocele. International Urogynecology Journal 2009;20(1):75‐81. - PubMed
Pantazis 2011 {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 [epub ahead of print]. 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]
Quadri 1985 {published data only}
    1. Quadri G, Scalambrino S, Boisio N, Marchesin R, Milani R. Randomized surgery for incontinence and prolapse: retropubic colposuspension vs anterior repair (abstract). Archives of Gynecology 1985;237(Suppl):402. [8019]
Rane 2004 {published data only}
    1. Rane A, Lim YN, Withey G, Muller R. Magnetic resonance imaging findings following three different vaginal vault prolapse repair procedures: a randomised study. Australian & New Zealand Journal of Obstetrics & Gynaecology 2004;44(2):135‐9. - PubMed
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 Urogynaecology 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 aniavulsion: a randomized controlled trial. Ultrasound in Obstetrics and Gynecology 2014;43(4):365–71. - PubMed
Tincello 2009 {published data only}
    1. Tincello DG, Kenyon S, Slack M, Toozs‐Hobson P, Mayne C, Jones D, et al. Colposuspension or TVT with anterior repair for urinary incontinence and prolapse: results of and lessons from a pilot randomised patient‐preference study (CARPET 1). British Journal of Obstetrics and Gynaecology 2009;116(13):1809‐14. - PubMed
    1. Tincello DG, Mayne CJ, Toozs‐Hobson P, Slack M. Randomised controlled trial of colposuspension versus anterior repair plus TVT for urodynamic stress incontinence with anterior vaginal prolapse: proposal (Abstract). International Continence Society, 11th Annual Scientific Meeting; 2004 Mar 18‐19; Bournemouth, United Kingdom. 2004:46. [17170]
Zargham 2013 {published data only}
    1. Zargham M, Alizadeh F, Tadayyon F, Khorrami MH, Nouri‐Mahdavi K, Gharaati MR, et al. Concomitant surgical correction of severe stress urinary incontinence and anterior vaginal wall prolapse by anterior vaginal wall wrap: 18 months outcomes. Journal of Research in Medical Sciences 2013;18(7):588‐93. - PMC - PubMed

References to ongoing studies

NCT01095692 {published data only}
    1. NCT01095692. Evaluating the necessity of TOT implantation in women with pelvic organ prolapse and occult stress urinary incontinence (ATHENA). www.ClinicalTrials.gov 2011:http://clinicaltrials.gov/ct2/show/NCT01095692 (accessed 19 April 2011). [41350]
NCT01802281 {published data only}
    1. SUPeR. Ongoing study April 2013.

Additional references

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, Issue 2. [DOI: 10.1002/14651858.CD004010.pub3] - DOI - PMC - PubMed
Ek 2010
    1. Ek M, Tegerstedt G, Falconer C, Kjaeldgaard A, Rezapour M, Rudnicki M, et al. Urodynamic assessment of anterior vaginal wall surgery: a randomized comparison between colporraphy and transvaginal mesh. Neurourology and Urodynamics 2010;29:527‐31. [39589] - PubMed
Ek 2011
    1. Ek M, Altman D, Elmér C, Gunnarsson J, Falconer C, Tegerstedt G. Clinical efficacy of a trocar guided mesh kit for the repair of anterior lateral defects (Abstract number 556). 41st Annual Meeting of the International Continence Society (ICS), 2011 Aug 29 to Sept 2, Glasgow, Scotland. 2011.
Ellström 2011
    1. Ellström Engh AM, Ekeryd A, Magnusson A, Olsson I, Otterlind L, Tobiasson G. Can de novo stress incontinence after anterior wall repair be predicted?. Acta Obstetricia et Gynecologica Scandinavica 2011;90(5):488‐493. - PubMed
GRADEproGDT 2015 [Computer program]
    1. McMaster University. GRADEpro GDT 2015. Version accessed 1 February 2018. Hamilton (ON): McMaster University, 2015. Available at gradepro.org.
Haessler 2005
    1. Haessler AL, Lin LL, Ho MH, Betson LH, Bhatia NN. Reevaluating occult incontinence. Current Opinion in Obstetrics and Gynecology 2005;17(5):535‐40. - 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
Haylen 2010
    1. Haylen BT, Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics 2010;29(1):4‐20. - 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 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011a
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8. Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
ICI 2017
    1. Maher CF, et al. Pelvic organ prolapse surgery. In: Abrams P, Cardozo L, Wagg A, Wein A editor(s). Incontinence. 6th Edition. Bristol: International Continence Society, 2017. [ISBN: 978‐0956960733]
Maher 2018
    1. Maher CF, Baessler KK, Barber MD, Cheon C, Consten ECJ, Cooper KG, et al. Summary: 2017 International Consultation on Incontinence Evidence‐Based Surgical Pathway for Pelvic Organ Prolapse. Female Pelvic Medicine & Reconstructive Surgery 2018 April 28 [Epub ahead of print]. [DOI: 10.1097/SPV.0000000000000591] - DOI - PubMed
Matsuoka 2015
    1. Matsuoka PK, Pacetta AM, Baracat EC, Haddad JM. Should prophylactic anti‐incontinence procedures be performed at the time of prolapse repair? Systematic review. International Urogynecology Journal 2015;26(2):187‐93. - PubMed
Reena 2007
    1. Reena C, Kekre AN, Kekre N. Occult stress incontinence in women with pelvic organ prolapse. International Journal of Gynecology & Obstetrics 2007;97(1):31‐4. - PubMed
RevMan 2014 [Computer program]
    1. Nordic Cochrane Centre: The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre: The Cochrane Collaboration, 2014.
Slieker‐ten Hove 2009
    1. Slieker‐ten Hove MC, Pool‐Goudzwaard AL, Eijkemans MJ, Steegers‐Theunissen RP, Burger CW, Vierhout ME. The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population. International Urogynecology Journal and Pelvic Floor Dysfunction 2009;20(9):1037‐45. - PMC - PubMed
Visco 2008
    1. Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P, et al. The role of preoperative urodynamic testing in stress‐continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. International Urogynecology Journal. 2008;19(5):607‐14. - 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
Maher 2016a
    1. Maher C, Feiner B, Baessler K, Christmann‐Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database of Systematic Reviews 2016, Issue 2. [DOI: 10.1002/14651858.CD012079] - DOI - PMC - PubMed
Maher 2016b
    1. Maher C, Feiner B, Baessler K, Christmann‐Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database of Systematic Reviews 2016, Issue 10. [DOI: 10.1002/14651858.CD012376] - DOI - PMC - PubMed
Maher 2016c
    1. Maher C, Feiner B, Baessler K, Christmann‐Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database of Systematic Reviews 2016, Issue 11. [DOI: 10.1002/14651858.CD004014.pub6] - DOI - PMC - PubMed
Mowat 2018
    1. Mowat A, Maher D, Baessler K, Christmann‐Schmid C, Haya N, Maher C. Surgery for women with posterior compartment prolapse. Cochrane Database of Systematic Reviews 2018, Issue 3. [DOI: 10.1002/14651858.CD012975] - DOI - PMC - PubMed

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