Cochrane · systematic review · CD012376
Surgery for women with apical vaginal prolapse
Maher, C, Yeung, E, Haya, N, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
54
current version
GRADE rated
54
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 6 · 11.1%Low 23 · 42.6%Moderate 23 · 42.6%High 2 · 3.7%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyVaginal procedure compared to sacral colpopexy (vault prolapse)
Population: women with apical vaginal vault prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse Vaginal procedure vs sacral colpopexy (vault prolapse) | RR 2.31 [1.27, 4.21] | 4 studies · 346 participants | Moderate Downgraded: risk of bias |
Surgery for recurrent prolapse Vaginal procedure vs sacral colpopexy (vault prolapse) | RR 2.33 [1.34, 4.04] | 6 studies · 497 participants | Moderate Downgraded: risk of bias |
Prolapse on examination (Stage 2 or above) ‐ Any recurrent prolapse Vaginal procedure vs sacral colpopexy (vault prolapse) | RR 1.87 [1.32, 2.65] | 5 studies · 422 participants | Moderate Downgraded: risk of bias |
Intraoperative Visceral injury Vaginal procedure vs sacral colpopexy (vault prolapse) | RR 0.46 [0.13, 1.63] | 7 studies · 625 participants | Moderate Downgraded: risk of bias |
Bladder Function ‐ Stress incontinence Vaginal procedure vs sacral colpopexy (vault prolapse) | RR 1.86 [1.17, 2.94] | 3 studies · 263 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Painful intercourse ‐ Dyspareunia Vaginal procedure vs sacral colpopexy (vault prolapse) | RR 3.44 [0.61, 19.53] | 3 studies · 106 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Operating time (minutes) Vaginal procedure vs sacral colpopexy (vault prolapse) | no estimate extracted | 6 studies · 517 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Cost (US dollars) Vaginal procedure vs sacral colpopexy (vault prolapse) | no estimate extracted | 2 studies · 188 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Vaginal hysterectomy compared to sacral hysteropexy/cervicopexy (uterine prolapse)
Population: women with apical uterine prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse) | RR 1.01 [0.1, 9.98] | 2 studies · 200 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Surgery for recurrent prolapse Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse) | RR 0.85 [0.47, 1.54] | 5 studies · 403 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Prolapse on examination (Stage 2 or greater) ‐ Any recurrent prolapse Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse) | RR 0.78 [0.54, 1.11] | 2 studies · 230 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Mesh exposure Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse) | RR 1.85 [0.7, 4.87] | 4 studies · 307 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Operating time (minutes) Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse) | no estimate extracted | 5 studies · 422 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Length of Hospital Stay (days) Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse) | no estimate extracted | 5 studies · 422 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Blood loss (mls) Vaginal hysterectomy vs sacral hysteropexy/cervicopexy (uterine prolapse) | no estimate extracted | 2 studies · 148 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Vaginal hysteropexy compared to sacral hysteropexy (uterine prolapse)
Population: women with apical uterine prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse) | RR 0.55 [0.21, 1.44] | 1 study · 257 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Surgery for recurrent prolapse Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse) | RR 1.34 [0.52, 3.44] | 2 studies · 345 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Prolapse on examination (Stage 2 or above) ‐ Any recurrent prolapse Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse) | RR 0.99 [0.83, 1.19] | 2 studies · 367 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Mesh exposure (1‐4 years) Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse) | RR 7.05 [0.37, 135.2] | 1 study · 257 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Painful intercourse ‐ De novo dyspareunia Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse) | RR 1.86 [0.72, 4.83] | 2 studies · 203 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Pelvic Floor Distress inventory (PFDI‐20) Vaginal hysteropexy vs sacral hysteropexy (uterine prolapse) | no estimate extracted | 1 study · 209 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Vaginal hysterectomy compared to vaginal hysteropexy (uterine prolapse)
Population: women with apical uterine prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse) | RR 1 [0.44, 2.24] | 2 studies · 365 participants | Moderate Downgraded: risk of bias |
Surgery for recurrent prolapse Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse) | RR 1.32 [0.67, 2.6] | 3 studies · 443 participants | Moderate Downgraded: risk of bias |
Prolapse on examination (Stage 2 or above) ‐ Any recurrent prolapse Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse) | RR 1.44 [0.79, 2.61] | 2 studies · 361 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
POP‐Q assessment Total Vaginal Length (TVL) Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse) | no estimate extracted | 3 studies · 413 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Bladder function ‐ Stress incontinence Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse) | OR 0.51 [0.22, 1.17] | 1 study · 175 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Painful intercourse ‐ Dyspareunia Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse) | RR 0.53 [0.13, 2.11] | 2 studies · 331 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Operating time (minutes) Vaginal hysterectomy vs vaginal hysteropexy (uterine prolapse) | no estimate extracted | 2 studies · 382 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Vaginal surgery with mesh compared to without mesh
Population: women with apical vaginal prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse Vaginal surgery with mesh vs without mesh | RR 1.08 [0.35, 3.3] | 1 study · 54 participants | Moderate Downgraded: imprecision, indirectness |
Surgery for recurrent prolapse Vaginal surgery with mesh vs without mesh | RR 0.57 [0.3, 1.06] | 5 studies · 450 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Prolapse on examination (Stage 2 or above) ‐ Any recurrent prolapse Vaginal surgery with mesh vs without mesh | RR 0.36 [0.09, 1.4] | 3 studies · 269 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Bladder injury Vaginal surgery with mesh vs without mesh | RR 3 [0.91, 9.89] | 4 studies · 445 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Mesh exposure Vaginal surgery with mesh vs without mesh | RR 14.75 [4.64, 46.89] | 5 studies · 499 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Bladder function ‐ Stress incontinence Vaginal surgery with mesh vs without mesh | RR 1.37 [0.97, 1.93] | 6 studies · 463 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) (lower score better function) Vaginal surgery with mesh vs without mesh | no estimate extracted | 3 studies · 180 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Vaginal uterosacral colpopexy compared to alternative vaginal native tissue apical suspension
Population: women with apical vaginal prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension | RR 0.88 [0.68, 1.15] | 1 study · 267 participants | Moderate Downgraded: imprecision, indirectness |
Surgery for recurrent prolapse Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension | RR 1.86 [0.66, 5.28] | 1 study · 228 participants | Moderate Downgraded: imprecision, indirectness |
Prolapse on examination ‐ Anterior compartment prolapse Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension | RR 1.14 [0.88, 1.48] | 3 studies · 588 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Prolapse on examination ‐ Apical compartment prolapse Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension | RR 0.8 [0.38, 1.67] | 3 studies · 587 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Prolapse on examination ‐ Posterior compartment prolapse Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension | RR 1.36 [0.79, 2.32] | 3 studies · 588 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Bladder function ‐ Stress urinary incontinence Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension | RR 1.6 [0.64, 3.98] | 1 study · 228 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Painful intercourse ‐ Dyspareunia Vaginal uterosacral colpopexy vs alternative vaginal native tissue apical suspension | RR 1.19 [0.73, 1.95] | 1 study · 228 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Absorbable compared to non absorbable sutures in apical prolapse surgery
Population: women with apical vaginal prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse Absorbable vs non absorbable sutures | RR 0.78 [0.39, 1.56] | 4 studies · 493 participants | Moderate Downgraded: risk of bias |
Surgery for recurrent prolapse Absorbable vs non absorbable sutures | no estimate extracted | 2 studies · 222 participants | High |
Prolapse on examination ‐ Any recurrent prolapse Absorbable vs non absorbable sutures | RR 0.82 [0.48, 1.4] | 3 studies · 417 participants | High |
Visceral injury ‐ Bladder Absorbable vs non absorbable sutures | RR 0.43 [0.11, 1.65] | 3 studies · 545 participants | Moderate Downgraded: risk of bias |
Suture/mesh exposure Absorbable vs non absorbable sutures | RR 0.25 [0.04, 1.6] | 5 studies · 688 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Painful intercourse ‐ Dyspareunia Absorbable vs non absorbable sutures | RR 0.11 [0, 3.91] | 2 studies · 161 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Sacral colpopexy: laparoscopic compared to alternative approach
Population: women with apical vaginal prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse: Laparoscopic versus open Sacral colpopexy: laparoscopic vs alternative approach | RR 2.06 [0.4, 10.54] | 2 studies · 193 participants | Low Downgraded: risk of bias, imprecision |
Surgery for recurrent prolapse Sacral colpopexy: laparoscopic vs alternative approach | RR 0.77 [0.26, 2.31] | 3 studies · 208 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Prolapse on examination (Stage 2 or more): Any recurrent prolapse Sacral colpopexy: laparoscopic vs alternative approach | RR 1.29 [0.64, 2.56] | 3 studies · 225 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Any complications (Clavien‐Dindo > 3) Sacral colpopexy: laparoscopic vs alternative approach | RR 1.26 [0.17, 9.44] | 2 studies · 193 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Operating time (minutes) Sacral colpopexy: laparoscopic vs alternative approach | no estimate extracted | 3 studies · 241 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Length of Hospital Stay (days) Sacral colpopexy: laparoscopic vs alternative approach | no estimate extracted | 3 studies · 246 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Vaginal procedure versus sacral colpopexy
Population: Women with apical compartment pelvic organ prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse (2 years) Vaginal procedure vs sacral colpopexy | RR 2.11 [1.06, 4.21] | 3 studies · 277 participants | Moderate Downgraded: imprecision |
Repeat surgery for prolapse (2 to 4 years) Vaginal procedure vs sacral colpopexy | RR 2.28 [1.2, 4.32] | 4 studies · 383 participants | Moderate Downgraded: imprecision |
Repeat surgery for stress urinary incontinence (2 years) Vaginal procedure vs sacral colpopexy | RR 1.87 [0.72, 4.86] | 4 studies · 395 participants | Moderate Downgraded: imprecision |
Recurrent prolapse on examination (1 to 2 years) Vaginal procedure vs sacral colpopexy | RR 1.89 [1.33, 2.7] | 4 studies · 390 participants | Moderate Downgraded: risk of bias |
Bladder injury Vaginal procedure vs sacral colpopexy | RR 0.57 [0.14, 2.36] | 5 studies · 511 participants | Moderate Downgraded: imprecision |
Stress urinary incontinence (2 years) Vaginal procedure vs sacral colpopexy | RR 1.86 [1.17, 2.94] | 3 studies · 263 participants | Moderate Downgraded: risk of bias |
Dyspareunia (2 years) Vaginal procedure vs sacral colpopexy | RR 2.53 [1.17, 5.5] | 3 studies · 106 participants | Low Downgraded: risk of bias, imprecision |
Vaginal surgery with mesh versus without mesh
Population: Women with apical vaginal prolapse
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness of prolapse (3 years) Vaginal surgery with mesh vs without mesh | RR 1.08 [0.35, 3.3] | 1 study · 54 participants | Low Downgraded: imprecision |
Repeat surgery for prolapse (1 to 3 years) Vaginal surgery with mesh vs without mesh | RR 0.69 [0.3, 1.6] | 5 studies · 497 participants | Low Downgraded: risk of bias, imprecision |
Repeat surgery for stress urinary incontinence (2 years) Vaginal surgery with mesh vs without mesh | RR 4.91 [0.86, 27.94] | 2 studies · 220 participants | Low Downgraded: imprecision |
Recurrent prolapse on examination (1‐3 years) Vaginal surgery with mesh vs without mesh | no estimate extracted | 3 studies · 269 participants | Low Downgraded: risk of bias, inconsistency |
Bladder injury Vaginal surgery with mesh vs without mesh | RR 3 [0.91, 9.89] | 4 studies · 445 participants | Very low Downgraded: risk of bias, imprecision |
Stress urinary incontinence (de novo 1 to 3 years) Vaginal surgery with mesh vs without mesh | RR 1.37 [0.94, 1.99] | 4 studies · 295 participants | Moderate Downgraded: risk of bias |
Dyspareunia (1 to 3 years) Vaginal surgery with mesh vs without mesh | RR 1.21 [0.55, 2.66] | 5 studies · 501 participants | Moderate Downgraded: risk of bias |