Fifty-four studies were included (n=7,054 participants): five full-text RCTs, three RCT abstracts, 17 non-randomised controlled studies and 29 case series. Three of the full-text RCTs used adequate allocation concealment and four reported losses to follow up (range 5% to 15%). Of the other 46 studies, 13 collected data prospectively and losses to follow-up ranged from 2% to 74%.
There was no significant difference between sacrocolpopexy (mesh) and sacrospinous colpopexy (no mesh) in risks of persistent symptoms (two RCTs) and vault prolapse recurrence (one RCT), between polypropylene and fascial lata in the risk of vault prolapse recurrence (one RCT) and between hysterectomy with and without mesh in the risk of uterine prolapse recurrence (one RCT).
Across all study designs, median risks (range) of persistent symptoms associated with each intervention were sacrocolpopexy 22% (3% to 31%, nine studies, n=638), sacrocolpoperineopexy 1.2% (one study, n=169), infracoccygeal sacropexy 8.8% (2% to 21%, three studies, n=262) and uterine sling 3.3% (range zero to 39%, three studies, n=91).
Across all study designs, median risks (range) of recurrent prolapse were sacrocolpopexy 1.2% (zero to 6.1%, 14 studies, n=1,054), sacrocolpoperineopexy 0.6% (one study, n=169), infracoccygeal sacropexy 4.8% (zero to 25%, nine studies, n=402) and uterine sling 3.3% (zero to 7.7%, five studies, n=136).
Across all study designs, median risks (range) of mesh erosion were sacrocolpopexy 5.4% (zero to 12%, 27 studies, n=2,922), sacrocolpoperineopexy 8.4% (8.3% to 8.5%, two studies, n=287), infracoccygeal sacropexy 6.7% (zero to 21%, 11 studies, n=889) and uterine sling 1.7% (zero to 3.3%, two studies, n=66).