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Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse

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Abstract

Introduction and hypothesis

The aim of this study is to estimate efficacy and safety of mesh in surgery for uterine or vault prolapse.

Methods

Seventeen electronic databases were searched for relevant studies that were published from 1980 onwards.

Results

Fifty-four studies involving 7,054 women were included. For sacrocolpopexy (average follow-up 23 months), the risk of clinical recurrence ranged from 0% to 6%, persistent symptoms ranged from 3% to 31% and mesh erosion from 0% to 12%. For infracoccygeal sacropexy (average follow-up 13 months), the risk of clinical recurrence ranged from 0% to 25%, persistent symptoms from 2% to 21% and mesh erosion 0% to 21%. Limited evidence was available for sacrocolpoperineopexy and uterine suspension sling to draw reliable estimates.

Conclusions

Sacrocolpopexy was associated with a low risk of recurrence but with a relatively high risk of mesh erosion. Ranges of estimates for outcomes for other mesh techniques were wide.

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Acknowledgements

The authors thank Adrian Grant (Health Services Research Unit, University of Aberdeen) for commenting on the study design; Georgios Lyratzopoulos and Sally Wortley (Interventional Procedures Programme, National Institute for Health and Clinical Excellence (NICE), UK) for commenting on the draft; James Browning (Mpathy Medical Devices Ltd.), Christine Clarke (Bard Ltd.), Hazel Edwards (American Medical Systems (UK), Ltd.), Adrian Griffiths (Johnson & Johnson Medical Ltd.), William Hynes (WL Gore & Associates (UK) Ltd.), and Coloplast Ltd. for providing properties of mesh produced by the manufacturers and published studies relating to mesh; and Paul Moran for providing additional information for a study identified from the National Research Register database.

Contribution to authorship

XJ and CG wrote this paper, and all authors contributed to its content. XJ screened the search results, contacted manufacturers, assessed studies for inclusion, undertook data abstraction and quality assessment, conducted data analysis and drafted the Interventional Procedures review on which this paper is based. CG drafted the scope, provided advice on study inclusion, determined outcome categories, drafted the background and methods sections of the review and commented on drafts of the review. GM commented on the scope of the review, drafted letters for contacting mesh manufacturers for additional information, supervised the conduct of the review and commented on drafts of the review. DJ provided advice on statistical analysis, checked the analysis results and commented on drafts of the review. CF developed and ran the literature search strategies, obtained papers, formatted the references and drafted sections concerning search strategies and search results. CB provided specialist advice on classification of mesh techniques and commented on drafts of the review. JB supervised the conduct of the review and commented on drafts of the review.

Funding

This manuscript is based on a systematic review commissioned and funded by the National Institute for Health and Clinical Excellence through its Interventional Procedures Programme. The Health Services Research Unit receives a core grant from the Chief Scientist Office of the Scottish Government Health Directorates. The views expressed are those of the authors and not necessarily those of the funding bodies.

Conflicts of interest

None.

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Authors and Affiliations

  1. Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK

    Xueli Jia, Cathryn Glazener, Graham Mowatt, David Jenkinson, Cynthia Fraser & Jennifer Burr

  2. Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK

    Christine Bain

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  1. Xueli Jia
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Correspondence to Xueli Jia.

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Fig. S1

Summary of quality assessment of the RCTs (full text, n = 5) (DOC 41 kb)

Fig. S2

Summary of quality assessment of the non-randomised comparative studies (n = 17) (DOC 41 kb)

Fig. S3

Summary of quality assessment of the case series (n = 29) (DOC 41 kb)

Appendix

Appendix

Table 6 Sacrocolpopexy: summary of patient characteristics and surgical procedures
Full size table
Table 7 Sacrocolpoperineopexy: summary of patient characteristics and surgical procedures
Full size table
Table 8 Infracoccygeal sacropexy: summary of patient characteristics and surgical procedures
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Table 9 Uterine suspension sling: summary of patient characteristics and surgical procedures (uterine prolapse only)
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Jia, X., Glazener, C., Mowatt, G. et al. Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse. Int Urogynecol J 21, 1413–1431 (2010). https://doi.org/10.1007/s00192-010-1156-7

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