Summary of findings for the main comparison. POP surgery with concomitant continence procedure compared to no concomitant continence procedure in women with POP and SUI.
| POP surgery with concomitant continence procedure compared to without concomitant continence procedure in women with POP and SUI | |||||||
| Patient or population: women with POP and SUI Setting: hospital Intervention: POP surgery with continence procedure Comparison: POP surgery without continence procedure | |||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | ||
| Risk with POP surgery without continence procedure | Risk with POP surgery with continence procedure | ||||||
| Vaginal POP surgery with vs without MUS Follow‐up: 12 months | Subjective postoperative SUI | 394 per 1000 | 118 per 1000 (75 to 189) | RR 0.30 (0.19 to 0.48) | 319 (2 RCTs) | ⊕⊕⊕⊝ Moderatea | |
| Recurrent POP on examination | No data available | ||||||
| Overactive bladder symptoms (cured/improved) | No data available | ||||||
| Voiding dysfunction | No data available | ||||||
| Vaginal POP surgery with vs without MUS Follow‐up: mean 12 months | Further continence surgery | 169 per 1000 | 7 per 1000 (0 to 125) | RR 0.04 (0.00 to 0.74) | 134 (1 RCT) | ⊕⊕⊕⊝ Moderatea | |
| Vaginal POP surgery with concomitant vs delayed continence surgery: additional concomitant MUS vs delayed MUS Follow‐up: mean 12 months | Subjective postoperative SUI | 113 per 1000 | 46 per 1000 (14 to 155) | RR 0.41 (0.12 to 1.37) | 140 (1 RCT) | ⊕⊕⊕⊝ Moderatea | |
| Recurrent POP on examination | No data available | ||||||
| Overactive bladder symptoms (cured/improved) | No data available | ||||||
| Voiding dysfunction | No data available | ||||||
| Further continence surgery | No data available | ||||||
| Abdominal POP surgery with vs without concomitant continence surgery: additional Burch colposuspension vs sacrocolpopexy alone: 1‐year FU | Subjective postoperative SUI | 391 per 1000 | 540 per 1000 (290 to 1000) | RR 1.38 (0.74 to 2.60) | 47 (1 RCT) | ⊕⊕⊕⊝ Moderatea | |
| Recurrent POP on examination | No data available | ||||||
| Overactive bladder symptoms (cured/improved) | 882 per 1000 | 750 per 1000 (538 to 1000) | RR 0.85 (0.61 to 1.18) | 33 (1 RCT) | ⊕⊕⊕⊝ Moderatea | ||
| Voiding dysfunction difficulties | 43 per 1000 | 42 per 1000 (3 to 627) | RR 0.96 (0.06 to 14.43) | 47 (1 RCT) | ⊕⊕⊝⊝ Lowa,b | ||
| Further continence surgery | No data available | ||||||
| *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; FU: follow‐up; MUS: mid‐urethral sling; POP: pelvic organ prolapse; RCT: randomised controlled trial; RR: risk ratio; SUI: stress urinary incontinence; | |||||||
| GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||||
aDowngraded one level for serious risk of bias ‐ no blinding of patients or assessors.
bDowngraded one level for serious imprecision with very low event rate and very wide confidence intervals, which cross line of no effect.