Guerette 2009

Methods	Multi‐centre RCT 24‐month follow‐up Randomisation computer generated Allocation concealment without blinding of women or surgeon Not according CONSORT Sample size was calculated by estimating a recurrence rate of 35% with AC and 10% with graft reinforcement. Assuming a 2‐tailed hypothesis test with 5% type 1 error and 80% power, 80 women would be required. We enrolled 94 women assuming a drop‐out rate of 15%
Participants	Randomised: Gp A 47, Gp B 47 2 years: Gp A 33, Gp B 26 Examination: Gp A 27, Gp B 17 Inclusion criteria: point Ba ≥ ‐1 Exclusion criteria: total vaginal length < 6 cm, severe atrophy, isolated paravaginal defect, allergic to bovine material, prior vaginal implant surgery, or ulceration
Interventions	A (n = 46): AC B (n = 44): AC with bovine pericardium collagen matrix graft reinforcement
Outcomes	Assessed at 6 months, 1 year, and 2 years Reports the following review outcomes: Awareness of prolapse: measure unclear Repeat surgery for prolapse Graft erosion/exposure ‐ no events POPQ assessment of prolapse: point Ba, C (reports median and range, no SDs) Sexual function: PISQ‐12 (no SDs reported); de novo dyspareunia at 1 year Quality of life: UDI‐6 (no SDs reported) Operating time ‐ reported as median and range
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated randomisation list
Allocation concealment (selection bias)	Low risk	Opaque envelopes opened in theatre (not consecutive)
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not stated
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not stated if assessors blinded, participant‐completed questionnaire
Incomplete outcome data (attrition bias) All outcomes	High risk	Equal losses in both groups; only 50% completed 2‐year review
Selective reporting (reporting bias)	Low risk	Reports main review outcomes
Other bias	High risk	Extensive COI reported; study partly funded Synovis Life Technologies, whose bovine pericardium product was being evaluated