The results of the search are presented as a PRISMA flow chart (Fig. 1). Forty RCTs remained after removal of duplicates and studies not matching the eligibility criteria (Table 1). The indications for AC were urinary incontinence [10,11,12], pelvic organ prolapse [13, 15, 16, 19,20,21,22,23, 25,26,27, 29,30,31,32,33,34,35,36,37,38, 40, 41, 43,44,45,46,47,48,49] or both [14, 17, 18, 24, 28, 39, 42].
In nine studies (22.5%) a standardized procedure was used [10, 25, 26, 33, 35, 43, 44, 47, 48], In one study a “similar preset”  as defined by the authors was mentioned, but in other studies the procedure was either not standardized or was not mentioned. In none of the studies was a complete list of steps of a standardized procedure presented.
In 23 studies (57.5%) preoperative/perioperative antibiotics were administered. Data concerning antibiotic administration was not provided in the remaining studies. The duration of antibiotic therapy was provided in 17 of the 23 studies: single shot antibiotics were administered in 14 studies, with a 2-day or 3-day regimen in each [25, 45]. Information concerning the type of antibiotic was given in 11 studies (27.5%). Cephalosporins were used in four studies: first-generation (cefazolin) in two [41, 43), second-generation (cefuroxime) in one , and third-generation (ceftriaxone) in one . Ampicillin plus clavulanic acid was used in two studies [18, 37. Combinations of two antibiotics (cephalosporin + clindamycin or metronidazole) were given in six studies: cefuroxime + clindamycin in one , cefuroxime + metronidazole in one , cefotaxime + metronidazole in one , cephalosporin + metronidazole in one , and cefazolin + metronidazole in two [37, 40].
Catheterization and management of residual urine
In 22 studies (55.0%) no comment was provided on preoperative/postoperative catheter use. In one study catheterization was performed according to the surgeon’s preference . Insertion was performed preoperatively in one study , postoperatively in six studies [15, 18, 19, 24, 37, 48] and intraoperatively in four studies [26, 31, 44, 45]; postoperative catheterization was not mentioned. In other studies, the time of insertion was not clear or was according to the surgeon’s preference . The type of catheter used was mentioned in seven studies: in two studies a transurethral Foley catheter was used [39, 41, 44], in two a suprapubic catheter [12, 14], in one a transurethral Foley catheter placed preoperatively and replaced postoperatively with a suprapubic catheter , and in one either a Foley or a suprapubic catheter . In seven studies the duration of catheterization was given: 24 h in three studies [40, 41, 43], “at least 2 days” in one study , “2–5 days” in one study , “72 h” in one study  and “5–7 days” in one study . In one study a suprapubic catheter was left at least 2 days, until residual urine was less than 50 ml . The management of residual urine was not mentioned in any of other studies.
Intraoperative fluid infiltration
In 12 studies (30.0%) fluid infiltration of the operating field was performed before the incision. A vasoconstricting solution was used in two studies (vasopressin in two [19, 47], adrenaline in two [16, 38]), and the type of agent used was not given in two studies [36, 41]. A mixture of anesthetics and vasoconstricting solution was used in six studies (lidocaine and adrenaline in four [21, 26, 33, 40], adrenalin and bupivacaine in two [22, 31]). It was unclear if infiltration was performed in the remaining studies.
Whether the colpotomy was performed with scalpel, scissors or cautery was not mentioned in any of the studies. In five studies the distance from the inferior margin of the incision to the external urethral orifice was given: 1 cm in two studies, 2 cm in two studies, and 1.5 cm in one study. In two studies the colpotomy was performed from the midurethra, in three from the urethrovesical junction, in one just below the meatus, and in one from the “proximal urethra”. In ten studies the incision was extended as far as the apex of the vagina or the cervix.
Instruments and techniques of dissection
For preparation of the cystocele before plication the following methods were used: “sharp” (three studies), “scissors” (two studies), “pointless detachment” (one study), “blunt or sharp” (three studies), and “scissors and blunt” (one study). In 30 studies (75.0%) no information was provided on this step of AC.
Various terms were used to describe the vesicovaginal fascia and possibly other structures that were claimed to have been used for plication (Table 2).
In 14 studies the anatomical limits of the preparation were mentioned and were described as follows: “median border of the decent pubic rami” (three studies), “the lateral sulci” (two studies), and (one study each) “inferior brim of the symphysis pubis”, “inferior pubic ramus”, “limits of pubic rami”, “pubic rami”, “the level of vaginal sulcus and urogenital diaphragm”, “ischio-pubic rami”, “the bladder base”, “vaginal sulci and proximally” and “white line“.
Plication techniques and suture material
In 19 studies (47.5%) interrupted sutures were used. The characteristics of the sutures are presented in Table 3. In one third of the studies no information was provided on the type of suture material, and a diverse range of suture materials were used in the remainder. The number of stitches was given in two studies [11, 31] but no information was provided on the length of the stitches or the distance between them.
In 18 studies trimming of the vagina was mentioned: trimming performed (12 studies), trimming optional/as required (three studies), and no trimming (three studies). In 22 studies no information on trimming was provided.
In 19 studies the material used was reported: Vicryl 2-0 (16 studies), and absorbable/delayed absorbable (three studies). A continuous suture was used in 12 studies (unlocked in two, locked in six, and no information in four) and interrupted suture in five studies (figure of eight in one, and overlapping for “prevention of trimming” in one).Intraoperative cystoscopy was mentioned in four studies (10%). In two, the cystoscopy was performed according to protocol, and in two according to the surgeon’s preference [33, 40].
Preoperative application of estrogen was mentioned in seven studies [10, 13, 25, 33, 41, 46, 48]. In two studies it was used in postmenopausal women for 4–6 weeks before surgery and for 3–4 weeks after surgery. In three studies the postoperative use of estrogen was recommended, but the duration of the proposed therapy was not mentioned. In one study 74% of the patients were treated with local estrogen preoperatively. In one study local estrogen at the time of study inclusion until 3 months after surgery was recommended.
Anesthesia was described in eight studies (20.0%) as follows: spinal (two studies), “in 90% spinal” (one study), regional (one study), doctor’s preference (one study), general (one study), epidural or spinal (one study), and general or regional (one study).
The number of surgeons was reported in 15 studies and ranged from 1 to 22. In one study “two surgeons performed the majority” of the operations, in five studies many surgeons and/or many centers participated, but the number of surgeons was not reported. Whether surgery was performed by a qualified urogynecologist was not reported in any of the studies. In nine studies (22.5%) some information was provided concerning the surgical team with the following heterogeneous descriptions: “same surgical team”, “surgeons with trainees”, “all qualified”, “experienced surgeons”, “house staff and one of three study surgeons”, “senior residents under supervision of the two senior authors“, “surgeons, supervised by a single physician“, and “surgeons from eight hospitals, who met at two workshops“.