Delroy 2013

Methods	Single‐centre non‐inferiority RCT Computer‐generated random number list Allocation at inclusion with surgeon aware only in operating theatre Envelopes allocation Sample size: 35 in each group, 80% power to detect 5% significant change with 10% drop‐out ITT analysis Assessors blinded Women unblinded
Participants	Any anterior POP point Ba ≥ +1 on POPQ Excluded malignant urogenital disease, prior radiation, acute genitourinary infection, connective tissue disorders, steroid treatments, insulin‐dependent diabetes
Interventions	All procedures under spinal by 3 experienced surgeons 1. AC: plicate fascia purse string 0 polyglactin (Vicryl), vaginal trimming, transvaginal trocar‐guided polypropylene mesh (kits donated by Promedon) Nazca TC (Promedon, Córdoba, Argentina) I prepubic and 2 transobturator macroporous monofilament; vagina closed overlapping fashion 355 accessed, 79 randomised AC 39 completed, 1‐year review n = 39 2. Anterior mesh 40 randomised, 40 completed 1‐year review Concomitant surgery as required
Outcomes	Assessed at 1 year Reports the following review outcomes: Awareness of prolapse: positive answer to at least 1 PQOL question on vaginal bulge, pelvis pain, sensation of prolapse (unusual combined measure ‐ data not used) Mesh exposure Bladder injury POPQ assessment of prolapse: point Ba, C, Bp, total vaginal length Sexual function: de novo dyspareunia Operating time Blood transfusion Days in hospital
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Random sequence generation tables
Allocation concealment (selection bias)	Unclear risk	Envelopes (opaque?, sealed?)
Blinding of participants and personnel (performance bias) All outcomes	High risk	Non‐blinded
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Blinded assessors
Incomplete outcome data (attrition bias) All outcomes	Low risk	79 randomised, and all completed 1‐year review
Selective reporting (reporting bias)	Unclear risk	Did not clearly report any of the primary outcomes of this review
Other bias	Low risk	Funded by Federal University of Sao Paulo, Brazil; Promedon contributed product free of charge No author COI