What do systematic reviews say?

Vaginal procedure vs sacral colpopexy (vault prolapse)

Vaginal procedure probably leads to higher awareness of prolapse compared with sacral colpopexy (vault prolapse) (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 2.31 [1.27, 4.21]
  4 studies · 346 participants
  Moderate

Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse)

Vaginal hysterectomy showed no clear difference in prolapse on examination (Stage 2 or greater) ‐ Any recurrent prolapse compared with sacral hysteropexy/cervicopexy (uterine prolapse) (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 0.78 [0.54, 1.11]
  2 studies · 230 participants
  Moderate

Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse)

It is very uncertain whether vaginal hysterectomy changes mesh exposure compared with sacral hysteropexy/cervicopexy (uterine prolapse) (very low certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 1.85 [0.7, 4.87]
  4 studies · 307 participants
  Very low

Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse)

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 422 participants
  Low

Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse)

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 422 participants
  Very low

Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse)

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 148 participants
  Low

Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse)

Vaginal hysteropexy showed no clear difference in awareness of prolapse compared with sacral hysteropexy (uterine prolapse) (low certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 0.55 [0.21, 1.44]
  1 study · 257 participants
  Low

Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse)

Vaginal hysteropexy showed no clear difference in prolapse on examination (Stage 2 or above) ‐ Any recurrent prolapse compared with sacral hysteropexy (uterine prolapse) (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 0.99 [0.83, 1.19]
  2 studies · 367 participants
  Moderate

Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse)

It is very uncertain whether vaginal hysteropexy changes mesh exposure (1‐4 years) compared with sacral hysteropexy (uterine prolapse) (very low certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 7.05 [0.37, 135.2]
  1 study · 257 participants
  Very low

Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse)

Vaginal hysteropexy showed no clear difference in painful intercourse ‐ De novo dyspareunia compared with sacral hysteropexy (uterine prolapse) (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 1.86 [0.72, 4.83]
  2 studies · 203 participants
  Moderate

Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse)

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 209 participants
  Low

Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse)

Vaginal hysterectomy showed no clear difference in awareness of prolapse compared with vaginal hysteropexy (uterine prolapse) (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 1 [0.44, 2.24]
  2 studies · 365 participants
  Moderate

Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse)

Vaginal hysterectomy showed no clear difference in prolapse on examination (Stage 2 or above) ‐ Any recurrent prolapse compared with vaginal hysteropexy (uterine prolapse) (low certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 1.44 [0.79, 2.61]
  2 studies · 361 participants
  Low

Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse)

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  no estimate extracted
  3 studies · 413 participants
  Low

Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse)

Vaginal hysterectomy showed no clear difference in bladder function ‐ Stress incontinence compared with vaginal hysteropexy (uterine prolapse) (low certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  OR 0.51 [0.22, 1.17]
  1 study · 175 participants
  Low

Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse)

Vaginal hysterectomy showed no clear difference in painful intercourse ‐ Dyspareunia compared with vaginal hysteropexy (uterine prolapse) (low certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 0.53 [0.13, 2.11]
  2 studies · 331 participants
  Low

Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse)

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  no estimate extracted
  2 studies · 382 participants
  Low

Vaginal procedure vs sacral colpopexy (vault prolapse)

Vaginal procedure probably leads to higher prolapse on examination (Stage 2 or above) ‐ Any recurrent prolapse compared with sacral colpopexy (vault prolapse) (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 1.87 [1.32, 2.65]
  5 studies · 422 participants
  Moderate

Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension

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

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 0.88 [0.68, 1.15]
  1 study · 267 participants
  Moderate

Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension

Vaginal uterosacral colpopexy showed no clear difference in prolapse on examination ‐ Anterior compartment prolapse compared with alternative vaginal native tissue apical suspension (moderate certainty).

• Surgery for women with apical vaginal prolapse 2023 · Cochrane Headline outcomes only
  RR 1.14 [0.88, 1.48]
  3 studies · 588 participants
  Moderate