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. 2018 Aug 19;2018(8):CD013108. doi: 10.1002/14651858.CD013108

Costantini 2008.

Methods Trial design: single‐site RCT
Participants Number of participants randomised: 47 (group A n = 24, group B n = 23)
Number of participants analysed: 47
Mean age (mean ± SD): group A = 60 ± 10, group B = 61 ± 13
Inclusion criteria: women age 18 to 75, POP > stage 2 (BW and POPQ), urinary incontinence defined by ICS
Exclusion criteria: uterine fibroids, uterine/cervical malignancy, active PID, allergy to synthetic graft/suture materials, pregnancy/lactation, significant illness, inability to provide informed consent or comply with study protocol 
Setting: Urology Department, University of Perugia, Italy
Timing: January 2002 to June 2006
Interventions Intervention: group A ‐ sacrocolpopexy + Burch 14, sacrohysteropexy + Burch 10 (n = 24)
Comparison: group B ‐ sacrocolpopexy 17, sacrohysteropexy 6, no colposuspension (n = 23)
Preoperatively incontinence defined by urodynamics: 13 USI, 30 mixed, 4 occult (incontinence with coughing or Valsalva manoeuvre with the prolapse reduced). Distribution of patients with prolapse and incontinence preoperatively between groups is unclear.
Outcomes Primary outcome/s: change in incontinence rate measured by combination of bladder diary, number of pads and stress test without clear definition, anatomical outcome of prolapse as measured by B7W and POPQ
Secondary outcome/s: changes in subjective symptoms and quality of life measured by questionnaires, postoperative satisfaction as measured by VAS
Notes CONSORT statement: yes    
Intention‐to‐treat analysis: All participants randomised were analysed.
Sample size calculation: yes, 47 participants calculated to provided 80% power to detect up to 30% difference in postoperative conditions between the 2 groups
Trial registration: yes (post hoc)
Clinicaltrials.gov NCT00576004
Funding: not stated.
Conflicts of interest: not stated
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Computer‐generated list
Allocation concealment (selection bias) Unclear risk No details were provided of the method used to conceal group allocation.
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Trial personnel who performed the operations were not blinded.
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Outcome assessors were blinded to group allocation.
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No loss to follow‐up
Selective reporting (reporting bias) Unclear risk All prespecified outcomes appear to have been reported.
Other bias Unclear risk Distribution of POP between groups not clear: 24 uterovaginal, 13 vault, 8 cystocoele, 2 cystocoele and rectocoele
Methodological problems with this paper include lack of clear and equal distribution of prolapse grading and incontinence between groups preoperatively, inconsistency of preoperative and postoperative incontinence classifications (urodynamics preoperatively and symptoms postoperatively), and lack of definition of success of prolapse grading and data related to perioperative parameters and complications.