title: Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review.
abstract: OBJECTIVE
  A previous version of the Cochrane review for prolapse surgery in 2008 provided two conclusions: abdominal sacrocolpopexy had lower recurrent vault prolapse rates than sacrospinous colpopexy but this was balanced against a longer time to return to activities of daily life. An additional continence procedure at the time of prolapse surgery might be beneficial in reducing post-operative stress urinary incontinence; however, this was weighed against potential adverse effects. The aim of this review is to provide an updated summary version of the current Cochrane review on the surgical management of pelvic organ prolapse.
  
  
  METHODS
  We searched the Cochrane Incontinence Group Specialised Register and reference lists of randomised or quasi-randomised controlled trials on surgery for pelvic organ prolapse. Trials were assessed independently by two reviewers.
  
  
  RESULTS
  We identified 40 trials including 18 new and three updates. There were no additional studies on surgery for posterior prolapse. Native tissue anterior repair was associated with more anterior compartment failures than polypropylene mesh repair as an overlay (RR 2.14, 95% CI 1.23-3.74) or armed transobturator mesh (RR 3.55, 95% CI 2.29-5.51). There were no differences in subjective outcomes, quality of life data, de novo dyspareunia, stress urinary incontinence, reoperation rates for prolapse or incontinence, although some of these data were limited. Mesh erosions were reported in 10% (30/293). Including new studies on the impact of continence surgery at the time of prolapse surgery, meta-analysis revealed that concurrent continence surgery did not significantly reduce the rate of post-operative stress urinary incontinence (RR 1.39, 95% CI 0.53-3.70; random-effects model).
  
  
  CONCLUSIONS
  The inclusion of new randomised controlled trials showed that the use of mesh at the time of anterior vaginal wall repair reduced the risk of recurrent anterior vaginal wall prolapse on examination. However, this was not translated into improved functional or quality of life outcomes. The value of a continence procedure in addition to a prolapse operation in women who are continent pre-operatively remains uncertain. Adequately powered randomised controlled trials are needed and should particularly include women's perceptions of prolapse symptoms and functional outcome.
authors.affiliation: Royal Brisbane and Wesley Hospitals Brisbane, Brisbane, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Maher
authors.forename: Benny
authors.initials: B
authors.lastname: Feiner
authors.forename: Kaven
authors.initials: K
authors.lastname: Baessler
authors.forename: Cathryn M A
authors.initials: CM
authors.lastname: Glazener
mesh_terms: D005260:Female; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011788:Quality of Life; D012008:Recurrence; D053825:Suburethral Slings; D013526:Surgical Mesh; D014550:Urinary Incontinence, Stress / Q000601:surgery