Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and or assessment of outcome).
A Cochrane review included 33 studies with a total of 3332 subjects. Recurrence after traditional native tissue repair (anterior colporrhaphy) in anterior compartment prolapse is not unusual. When native tissue was compared with biological graft, there was no difference in repeat surgery, stress urinary incontinence, or dyspareunia, but increased risk of recurrence of prolapse (table ; moderate quality evidence). When native tissue was compared with polypropylene mesh, there was increased risk of awareness of prolapse, repeat surgery for prolapse (moderate quality evidence), no difference in SUI or dyspareunia, but decreased risk for repeat surgery for prolapse, stress urinary incontinence or mesh exposure (compsite outcome; moderate quality evidence) (table ). When native tissue was compared with absorbable mesh, there was no clear diffrence in awareness of prolapse or repeat surgery for prolapse (low quality evidence), but increased risk for recurrent anterior compartment prolapse (RR 1.50, 95% CI 1.09 to 2.06; 3 trials, n=268; moderate-quality evidence).
| Outcome (1-2 years) | Relative effect (95% CI) | Assumed risk - Control - Biological graft | Corresponding risk - Native tissue (95% CI) | No of participants (studies) |
|---|---|---|---|---|
| Awareness of prolapse | RR 0.98 (0.52 to 1.82) | 124 / 1000 | 122 / 1000 (65 to 226) | 552 (5) |
| Repeat surgery for prolapse | RR 1.02 (0.53 to 1.97) | 44 / 1000 | 45 / 1000 (23 to 86) | 650 (7) |
| Recurrent anterior compartment prolapse | RR 1.32 (1.06 to 1.65) | 257 / 1000 | 340 / 1000 (273 to 424) | 701 (8) |
| Stress urinary incontinence | RR 1.44 (0.79 to 2.64) | 130 / 1000 | 187 / 1000 (102 to 342) | 218 (2) |
| Outcome (1-3 years) | Relative effect (95% CI) | Assumed risk - Control - Polypropylene mesh | Corresponding risk - Native tissue (95% CI) | No of participants (studies) |
|---|---|---|---|---|
| Awareness of prolapse | RR 1.77 (1.37 to 2.28) | 130 / 1000 | 230 / 1000 (178 to 297) | 1133 (9) |
| Repeat surgery for prolapse | RR 2.03 (1.15 to 3.58) | 18 / 1000 | 37 / 1000 (21 to 66) | 1629 (12) |
| Recurrent anterior compartment prolapse | RR 3.01 (2.52 to 3.60) | 126 / 1000 | 379 / 1000 (317 to 453) | 1976 (16) |
| Repeat surgery for prolapse, SUI or mesh exposure | RR 0.59 (0.41 to 0.83) | 97 / 1000 | 54 / 1000 | 1527 (12) |
Date of latest search:23 August 2016