Introduction
Materials and methods
Types of studies
Types of participants
Types of interventions
Types of outcomes
Data collection
Data extraction and management
Assessment of risk of bias in the studies included
Analysis
Results
Study selection
Characteristics of the studies included
Participants
Interventions
Follow-up time
Outcomes
Reference | Number of patients (umber lost to follow-up if known) | Follow-up (months) | Intervention | Assessment of subjective outcome | Criteria for success | Objective success rate (%) | Re-operation (%) |
---|---|---|---|---|---|---|---|
[20] | 95 (6) | ASC 24 (6–60) and SSF 22 (6–58) | ASC vs SSF | Baden–Walker | No prolapse grade 2 | 85 vs 81, p = 0.78 | |
[19] | 100 (11) | 12 | ASC: fascia lata vs polypropylene mesh | POP-Q | No prolapse ≥stage 2 | 68 vs 91, p = 0.007 | |
[18] | 100 (31) | 60 | ASC: fascia lata vs polypropylene mesh | POP-Q | Objective success: no prolapse ≥stage 2 Clinical success: no bulge or prolapse symptoms and point C <1/2TVL or any POP-Q point ≤0 | 62 vs 93, p = 0.02 90 vs 97, p = 0.61 | |
[17] | 53 | 12 | ASC vs LSC | POP-Q | Not defined | No difference | 0 vs 1 |
[16] | 74 | 12 | ASC vs LSC | POP-Q | No prolapse beyond the hymen, no bulge symptoms, and no repeat surgery | 84 vs 89 | 1 vs 5 (RR 4, 95% CI 0.84–5.73) |
[23] | 108 (3) | 24 | LSC vs VM | POP-Q | Stage 0 or 1 prolapse at all vaginal sites | 77 vs 43, p < 0.001 | |
[24] | 78 (17) | 12 | LSC vs RSC | POP-Q | Not defined | 91 vs 88, NS (stage 0–1) 9 vs 12 NS (stage 2) | |
[21] | 168 (17) | 12 | SSF vs VM | POP-Q | No prolapse ≥stage 2 | 61 vs 83 | |
[22] | 70 (0) | 12 | SSF vs VM | POP-Q | Point Ba, C or Bp <0 and translabial ultrasound: bladder descent <10 mm below the lower margin of the symphysis pubis on maximum Valsalva | 35 vs 97, p < 0.001 |
Reference | Number of patients (number lost to follow-up if known) | Follow-up (months) | Intervention | Assessment of subjective outcome | Outcome(s) | Result(s) (%) |
---|---|---|---|---|---|---|
[20] | 95 (6) | Mean ASC 24 (6–60) and SSF 22 (6–58), p = 0.65 | ASC vs SSF | UDI-6, IIQ, SF-36, modified sexual function questionnaires, VAS for patient satisfaction | Subjective success rate Patient satisfaction | 94 vs 91, p = 0.19 85 vs 81, p = 0.78 |
[19] | 100 (11) | 12 | ASC: fascia lata vs polypropylene mesh | No outcome | No outcome | No outcome |
[18] | 100 (31) | 60 | ASC: fascia lata vs polypropylene mesh | Clinical success: no bulge or prolapse symptoms and point C <1/2TVL or any POP-Q point ≤0 | Combined subjective and objective outcome | 90 vs 97, p = 0.61 |
[17] | 53 (6) | 12 | ASC vs LSC | PGI-I, P-QOL, SF-36 | Subjective outcome Quality of life | PGI-I score 1 and 2 combined 90 vs 80 No difference |
[16] | 74 (1) | 12 | ASC vs LSC | UDI, DDI, IIQ, PGI-I | Subjective outcome | No difference |
[23] | 108 (3) | 24 | LSC vs VM | APFQ, P-QOL, VAS for patient satisfaction | Symptomatic prolapse Mean patient satisfaction Subjective outcome | 2 vs 7, p = 0.18 OR 4.75 (95% CI 2.06–10.98) 87 ± 21 vs 79 ± 20, p = 0.002 Mean difference 8.09 (95% CI, 0.20 –15.98) No difference |
[24] | 78 (17) | 12 | LSC vs RSC | PFDI-20, PFIQ-7, PISQ, EQ-5D | Subjective outcome Quality of life | No difference No difference |
[21] | 168 (17) | 12 | SSF vs VM | PISQ, UIQ, CRAIQ, POPIQ | Subjective outcome Quality of life | No difference No difference |
[22] | 70 (0) | 12 | SSF vs VM | ICIQ-SF, PISQ-12, POPDI, UDI, CRADI | Subjective outcome | No difference |
Allocation
Performance and detection bias
Incomplete outcome data
Reporting bias
Confounders
Other risk of bias
Anatomical outcome
Subjective outcome on urogenital symptoms and quality of life
Complications
Reference | [20] | [19] | [18] | [17] | [16] | [23] | [24] | [21] | [22] |
---|---|---|---|---|---|---|---|---|---|
Comparison | ASC vs SSF | ASC: fascia lata vs polypropylene mesh | ASC: fascia lata vs polypropylene mesh | ASC vs LSC | ASC vs LSC | LSC vs VM | LSC vs RSC | SSF vs VM | SSF vs VM |
Operative time (min) | |||||||||
Mean (range) | 106 ± 37 (45–100) vs 76 ± 42 (26–300) (p < 0.01) | 233.4 ± 66.9 vs 227.3 ± 63.3 (p = 0.40) | Not mentioned | 131 ± 44 vs 144 ± 28 (p = 0.24) | 113 (68–180) vs 125 (85–240) (p = 0.31) | 97 (36–280) vs 50 (30–96) (p < 0.001) | 199 ± 46 (109–329) vs 265 ± 50 (191–381) (p < 0.001) | 80 (15–50) vs 65 (35–166) (p = 0.001) | Not mentioned |
Estimated blood loss (ml) | |||||||||
Mean (range) | 362 ± 239 (100–1,100) vs 306 ± 201 (100–1,000) (p = 0.22) | 264.7 ± 261.4 vs 247.2 ± 148.4 (p = 0.68) | Not mentioned | 240.4 ± 231.7 vs 56.15 ± 34.3 (p < 0.01) | 205 (10–650) vs 86 (0–1,200) (p < 0.01) | 100 (20–300) vs 150 (21–500) (p = 0.004) | Not mentioned | 110 (10–528) vs 120 (10–814) (p = 0.39) | Not mentioned |
Hospital stay (days) | |||||||||
Mean (range) | 5.4 ± 2.2 (3–16) vs 4.8 ± 1.4 (3–10) (p = 0.16) | Not mentioned | Not mentioned | 4.1 ± 1.6 vs 3.2 ± 1.1 (p = 0.02) | 4.3 (2–12) vs 2.4 (1–4) (p < 0.01) | 2 (2–10) vs 3 (2–6) (p = 0.01) | 1.4 ± 0.5 (0.6–2.7) vs 1.8 ± 1.5 (0.8–10) (p = 0.17) | Not mentioned | Not mentioned |
Complications, % (n/m)a
| |||||||||
Grade 1 | 0 vs 2.1 (1/48) | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 2.9 (1/35) | 6.8 (5/73) vs 0 | 0 vs 2.8 (1/36) |
Grade 2 | 2.1 (1/47) vs 0 | 4.3 (2/46) vs 5.6 (3/54) | 0 vs 0 | 0 vs 0 | 2.7 (1/37) vs 5.6 (2/36) | 3.8 (2/53) vs 10.9 (6/55) | 9.1 (3/33) vs 28.6 (10/35) | 6.9 (5/73) vs 8.9 (7/79) | 0 vs 0 |
Grade 3 | 10.6 (5/47) vs 6.3 (3/48) | 10.9 (5/46) vs 25.9 (14/54) | 2.3 (1/44) vs 4.4 (2/45) | 7.4 (2/27) vs 7.7 (2/26) | 13.5 (5/37) vs 5.6 (2/36) | 9.4 (5/53) vs 18.2 (10/55) | 9.1 (3/33) vs 22.9 (8/35) | 9.6 (7/73) vs 34.2 (25/73) | 0 vs 5.6 (2/36) |
Grade 4 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 |
Grade 5 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 2.7 (1/37) vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 | 0 vs 0 |
Intervention details
Operating time
Blood loss
Recurrence of pelvic organ prolapse
Technique | ASC | LSC | RSC | VM | SSF | |
---|---|---|---|---|---|---|
Mesh | Fascia | |||||
Studies | 5 | 1 | 4 | 1 | 3 | 3 |
n
| 186 | 29 | 154 | 40 | 176 | 165 |
POP-Q point C | ||||||
[17]: −6.63 (SD 1.35) [16]: −6.7 (SD 1.9) [18]: −9.0 (SD 1.2) Vault to/beyond hymen [20]: 4% (2) | [18]: −8.1 (SD 2.7) | [17]: −6.65 (SD 1.19) [16]: −6.5 (SD 1.6) [20]: −7.48 (SD 2.62) [24]: −10 (range −11 to −5) | [24]: −9 (range −11 to −6) | [20]: −6.11 (SD 2.72) [21]: −5.99 [22]: −6.2 (SD 1.29) | [21]: −4.94 [22]: −3.2 (SD 3.56) Vault to/beyond hymen: [20]: 19% (8) | |
POP-Q stage < 2 | ||||||
[20]: 76% (35/46)a
[16]: 66% (19/29) [19]: 91% (41/45)b
[18]: 93% (27/29)b
| [18]: 62% (18/29)b
[19]: 61% (30/44)b
| [16]: 72% (21/29) [20]: 77% (41/53) | – | [20]: 43% (23/55) [21]: 83% [22]: 97%c
| [20]: 69% (29/42)a
[21]: 61% [22]: 35%c
| |
Re-operations | ||||||
(for POP, incontinence, complications) | [20]: 13% (6/47) [18]: 6% (3/54) [17]: 11% (3/27) [16]: 19% (7/36) | [18]: 4% (2/46) | [20]: 6% (3/53) [17]: 12% (3/26) [16]: 19% (7/37) | [20]: 22% (12/55) [21]: 13% (11/85) [22]: 31% (11/36) | [21]: 5% (4/83) [22]: 18% (6/34) [20]: 27% (13/48) | |
Re-operations for POP | ||||||
[20]: 2% (1/47) [18]: 2% (1/54) [17]: 0% (0/27) [16]: 3% (1/37) | [18]: 2% (1/46) | [17]: 4% (1/26) [16]: 11% (4/37) [20]: 0% (0/53) | – | [20]: 5% (3/55) [21]: 1% (1/85) [22]: 0% (0/36) | [20]: 6% (3/48) [21]: 5% (4/83) [22]: 9% (3/34) | |
Mesh exposure | ||||||
[17]: 0% (0/27) [16]: 0% (0/37) [18]: 2% (1/54) | [18]: 2% (1/54) | [17]: 0% (0/26) [16]: 0% (0/37) [20]: 2% (1/53) [24]: 0% (0/38) | [24]: 5% (2/40) | [20]: 13% (7/55) [21]: 21% (16/79) [22]: 8% (3/36) | ||
Dyspareunia | ||||||
[20]: 20% (9) | – | – | – | [22]: 6% (2/34) | [20]: 19% (9) [22]: 3% (1/36) | |
De novo incontinence | ||||||
Any incontinence: [17]: 15% (4/27) UUI: [16]: 8% (3/37) SUI: [20]: 9% (2/22) [16]: 11% (4/37) | – | Any incontinence: [17]: 8% (2/26) UUI: [16]: 5% (2/37) SUI: [16]: 14% (5/37) | – | SUI: [22]: 38% (13/34) | SUI: [20]: 33% (8/24) [22]: 8% (3/36) |