What do systematic reviews say?

Vaginal surgery with mesh vs non‐mesh repair

Vaginal surgery with mesh showed no clear difference in surgery for recurrent prolapse compared with without mesh (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 0.57 [0.3, 1.06]
  5 studies · 450 participants
  Moderate

Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse)

Vaginal hysterectomy showed no clear difference in surgery for recurrent prolapse compared with sacral hysteropexy/cervicopexy (uterine prolapse) (low certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 0.85 [0.47, 1.54]
  5 studies · 403 participants
  Low

Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse)

Vaginal hysteropexy showed no clear difference in surgery for recurrent prolapse compared with sacral hysteropexy (uterine prolapse) (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 1.34 [0.52, 3.44]
  2 studies · 345 participants
  Moderate

Vaginal procedure vs sacral colpopexy (vault prolapse)

Vaginal procedure probably leads to higher surgery for recurrent prolapse compared with sacral colpopexy (vault prolapse) (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 2.33 [1.34, 4.04]
  6 studies · 497 participants
  Moderate

Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse)

Vaginal hysterectomy showed no clear difference in surgery for recurrent prolapse compared with vaginal hysteropexy (uterine prolapse) (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 1.32 [0.67, 2.6]
  3 studies · 443 participants
  Moderate

Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension

Vaginal uterosacral colpopexy showed no clear difference in surgery for recurrent prolapse compared with alternative vaginal native tissue apical suspension (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 1.86 [0.66, 5.28]
  1 study · 228 participants
  Moderate

Absorbable vs non‐absorbable sutures

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 222 participants
  High

Sacral colpopexy: laparoscopic vs alternative approach

Sacral colpopexy: laparoscopic showed no clear difference in surgery for recurrent prolapse compared with alternative approach (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 0.77 [0.26, 2.31]
  3 studies · 208 participants
  Moderate

Transvaginal biological graft vs native tissue repair

Transvaginal biological graft showed no clear difference in surgery for recurrent prolapse (1 to 2 years) compared with native tissue repair (moderate certainty).

• Transvaginal mesh or grafts or native tissue repair for vaginal prolapse 2024 · Cochrane Headline outcomes only
  RR 1.15 [0.75, 1.77]
  6 studies · 899 participants
  Moderate