Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding of outcome assessment in half ot the studies) and by imprecise results (wide confidence intervals and few outcome events).
A Cochrane review included 30 studies with a total of 3414 subjects. Vaginal procedures versus sacral colpopexy: After vaginal procedures, awareness of prolapse, recurrent prolapse, repeat surgery for prolapse, and stress urinary incontinence (SUI) were more common (table ). There was no conclusive evidence that vaginal procedures increased bladder injury or repeat surgery for SUI (table). Vaginal surgery with mesh versus without mesh: There was no clear difference in awareness of prolapse, recurrent prolapse, or repeat surgery for prolapse (table ). The confidence interval were very wide. There is probably little or no difference between the groups in rates of SUI (de novo) or dyspareunia (RR 1.21, 95% CI 0.55 to 2.66; 5 RCTs, n = 501; moderate-quality evidence).
| Outcome | Relative effect (95% CI) | Assumed risk - Control - Sacral colpopexy | Corresponding risk - Intervention - Vaginal surgery (95% CI) | No of Participants (studies) Quality of evidence |
|---|---|---|---|---|
| Awareness of prolapse (2 years) | RR 2.11 (1.06 to 4.21) | 65 / 1000 | 137 / 1000 (69 to 274) | 277 (3) Moderate |
| Repeat surgery for prolapse (2 to 4 years) | RR 2.28 (1.20 to 4.32) | 41 / 1000 | 93 / 1000 (49 to 177) | 383 (4) Moderate |
| Recurrent prolapse on examination (1 to 2 years) | RR 1.89 (1.33 to 2.70) | 232 / 1000 | 438 / 1000 (309 to 626) | 390 (4) Moderate |
| Repeat surgery for SUI (2 years) | RR 1.87 (0.72 to 4.86) | 32 / 1000 | 61 / 1000 (23 to 157) | 395 (4) Moderate |
| Bladder injury | RR 0.57 (0.14 to 2.36) | 16 / 1000 | 9 / 1000 (2 to 39) | 511 (5) Moderate |
| Stress urinary incontinence (2 years) | RR 1.86 (1.17 to 2.94) | 139 / 1000 | 259 / 1000 (163 to 409) | 263 (3) Moderate |
| Outcome | Relative effect (95% CI) | Assumed risk - Control - Vaginal colpopexy | Corresponding risk - Intervention - Vaginal mesh | No of Participants (studies) Quality of evidence |
|---|---|---|---|---|
| Awareness of prolapse (3 years) | 1.08 (0.35 to 3.30) | 179 / 1000 | 193 / 1000 (63 to 589) | 54 (1) Low |
| Repeat surgery for prolapse (1 to 3 years) | 0.69 (0.3 to 1.60) | 42 / 1000 | 29 / 1000 (13 to 67) | 497 (5) Low |
| Recurrent prolapse on examination (1-3 years) | 0.36 (0.09 to 1.40) | 615 / 1000 | 222 / 1000 (55 to 862) | 269 (3) Low |
| Repeat surgery for SUI (2 years) | 4.91 (0.86 to 27.94) | 19 / 1000 | 94 / 1000 (17 to 536) | 220 (2) Low |
| Bladder injury | 3.00 (0.91 to 9.89) | 13 / 1000 | 38 / 1000 (11 to 124) | 445 (4) Very low |
| SUI (de novo 1 to 3 years) | 1.37 (0.94 to 1.99) | 219 / 1000 | 300 / 1000 (206 to 436) | 295 (4) Moderate |
Date of latest search: 6 July 2015