Summary of findings 2. Anterior prolapse repair: native tissue versus polypropylene mesh for women with anterior compartment pelvic organ prolapse.
| Anterior prolapse repair: native tissue versus polypropylene mesh for women with anterior compartment pelvic organ prolapse | ||||||
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Patient or population: women with anterior compartment pelvic organ prolapse Setting: hospital departments of obstetrics and gynaecology Intervention: native tissue (anterior repair, colporrhaphy) Comparison: polypropylene mesh | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Polypropylene mesh repair | Native tissue repair | |||||
| Awareness of prolapse (1‐3 years) | 130 per 1000 | 230 per 1000 (178 to 297) | RR 1.77 (1.37 to 2.28) | 1133 (9 studies) | ⊕⊕⊕⊝ Moderate1 | |
| Repeat surgery for prolapse (1‐3 years) | 18 per 1000 | 37 per 1000 (21 to 66) | RR 2.03 (1.15 to 3.58) | 1629 (12 studies) | ⊕⊕⊕⊝ Moderate2 | |
| Repeat surgery for stress urinary incontinence (1‐2 years) | 29 per 1000 |
35 per 1000 (17 to 69) |
RR 1.19 (0.60 to 2.36) |
881 (5 studies) |
Low3,4 | |
| Recurrent anterior compartment prolapse (1‐3 years) | 126 per 1000 | 379 per 1000 (317 to 453) | RR 3.01 (2.52 to 3.60) | 1976 (16 studies) | ⊕⊕⊝⊝ Low5,6 | |
| Stress urinary incontinence (de novo) (1‐3 years) | 102 per 1000 | 69 per 1000 (45 to 103) | RR 0.67 (0.44 to 1.01) | 957 (6 studies) | ⊕⊕⊝⊝ Low4,7 | |
| Dyspareunia (de novo) (1‐2 years) | 72 per 1000 |
39 per 1000 (19 to 76) |
RR 0.54 (0.27 to 1.06) |
583 (8 studies) |
⊕⊕⊕⊝ Low4,7 | |
| Repeat surgery for prolapse, SUI or mesh exposure (1‐3 years) | 97 per 1000 | 54 per 1000 |
RR 0.59 (0.41 to 0.83) |
1527 (12 studies) |
⊕⊕⊕⊝ Moderate2 | |
| *The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI = confidence interval; RR = risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Risk of bias: allocation concealment not reported in 4/9, downgraded one level. 2Risk of bias: allocation concealment not reported in 6/12, downgraded one level.
3Risk of bias: allocation concealment not reported in 2/5: downgraded one level.
4Serious imprecision: wide CI with lower RR (0.25), downgraded one level.
5Risk of bias: 11/15 trials did not report blinded outcome assessment, downgraded one level.
6Risk of bias: allocation concealment not reported in 7/15, downgraded one level.
7Risk of bias: poor methodological reporting of allocation concealment and/or blinding, downgraded one level.