Comparison 1.

Any transvaginal permanent mesh versus native tissue repair

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Awareness of prolapse (1‐3 years)	12	1614	Risk Ratio (M‐H, Fixed, 95% CI)	0.66 [0.54, 0.81]
1.1 Anterior compartment:mesh vs native tissue	9	1172	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.51, 0.84]
1.2 Multicompartment: mesh vs native tissue	4	442	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.46, 0.97]
2 Repeat surgery (1‐3 years)	14		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
2.1 Prolapse	12	1675	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.31, 0.88]
2.2 Continence surgery	9	1284	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.62, 1.83]
2.3 Surgery for prolapse, SUI or mesh exposure	7	867	Risk Ratio (M‐H, Fixed, 95% CI)	2.40 [1.51, 3.81]
3 Recurrent prolapse (any) at 1‐3 years	21	2494	Risk Ratio (M‐H, Random, 95% CI)	0.40 [0.30, 0.53]
3.1 Anterior compartment repair: mesh versus native tissue	15	1748	Risk Ratio (M‐H, Random, 95% CI)	0.33 [0.26, 0.40]
3.2 Multi‐compartment repair: mesh versus native tissue	6	746	Risk Ratio (M‐H, Random, 95% CI)	0.59 [0.40, 0.87]
4 Injuries bladder or bowel	11		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only
4.1 Bladder injury	11	1514	Risk Ratio (M‐H, Fixed, 95% CI)	3.92 [1.62, 9.50]
4.2 Bowel injury	1	169	Risk Ratio (M‐H, Fixed, 95% CI)	3.26 [0.13, 78.81]
5 Objective failure of anterior compartment (cystocoele)	13	1406	Risk Ratio (M‐H, Fixed, 95% CI)	0.45 [0.36, 0.55]
5.1 Anterior compartment repair: mesh versus native tissue	9	1004	Risk Ratio (M‐H, Fixed, 95% CI)	0.36 [0.28, 0.47]
5.2 Multi‐compartment repair: mesh versus native tissue	4	402	Risk Ratio (M‐H, Fixed, 95% CI)	0.73 [0.51, 1.06]
6 Objective failure of posterior compartment (rectocoele)	3	226	Risk Ratio (M‐H, Fixed, 95% CI)	0.64 [0.29, 1.42]
6.1 Mesh vs native tissue	3	226	Risk Ratio (M‐H, Fixed, 95% CI)	0.64 [0.29, 1.42]
7 POPQ assessment (any mesh)	10		Mean Difference (IV, Random, 95% CI)	Subtotals only
7.1 Point Ba POPQ	10	1125	Mean Difference (IV, Random, 95% CI)	‐0.93 [‐1.27, ‐0.59]
7.2 Point C POPQ	8	925	Mean Difference (IV, Random, 95% CI)	‐0.45 [‐1.13, 0.23]
7.3 Point Bp	7	832	Mean Difference (IV, Random, 95% CI)	0.05 [‐0.34, 0.44]
7.4 total vaginal length	5	611	Mean Difference (IV, Random, 95% CI)	0.07 [‐0.25, 0.40]
8 Bladder function: de novo stress urinary incontinence (1‐3 years)	12	1512	Risk Ratio (M‐H, Fixed, 95% CI)	1.39 [1.06, 1.82]
8.1 Anterior compartment: mesh vs native tissue	8	1205	Risk Ratio (M‐H, Fixed, 95% CI)	1.45 [1.00, 2.11]
8.2 Multi compartment : mesh vs native tissue	4	307	Risk Ratio (M‐H, Fixed, 95% CI)	1.31 [0.90, 1.92]
9 De novo voiding disorder, urgency, detrusor overactivity or overactive bladder	3	236	Risk Ratio (M‐H, Fixed, 95% CI)	0.75 [0.35, 1.63]
10 De novo dyspareunia (1‐3 years)	11	764	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.58, 1.47]
10.1 Anterior compartment: mesh vs native tissue	8	643	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.60, 1.93]
10.2 Multicompartment: mesh vs native tissue	3	121	Risk Ratio (M‐H, Fixed, 95% CI)	0.65 [0.29, 1.42]
11 Sexual function (1‐3 years)	7		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
11.1 PISQ score	7	857	Mean Difference (IV, Fixed, 95% CI)	‐0.13 [‐0.40, 0.13]
12 Quality of life: continuous data (1‐2 years):	7	665	Std. Mean Difference (IV, Random, 95% CI)	0.05 [‐0.20, 0.30]
12.1 PQOL end score	3	331	Std. Mean Difference (IV, Random, 95% CI)	0.09 [‐0.31, 0.49]
12.2 Pelvic floor impact questionnaire end score	4	334	Std. Mean Difference (IV, Random, 95% CI)	0.02 [‐0.34, 0.37]
13 Quality of life: dichotomous data "much or very much better"	1	168	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.80, 1.25]
13.1 PGI‐I	1	168	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.80, 1.25]
14 Operating time (minutes)	13		Mean Difference (IV, Random, 95% CI)	Totals not selected
14.1 Anterior compartment: mesh vs native tissue	10		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
14.2 Multicompartment: mesh vs native tissue	3		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
15 Blood transfusion	6	723	Risk Ratio (M‐H, Fixed, 95% CI)	1.55 [0.88, 2.72]
16 Length of stay in hospital (days)	7	953	Mean Difference (IV, Random, 95% CI)	‐0.06 [‐0.30, 0.18]