Native tissue repair (NTR) versus transvaginal mesh interventions for the treatment of anterior vaginal prolapse: Systematic review and meta-analysis. (November 2022)

• Record Type: Journal Article
• Authors: Capobianco, Giampiero; Sechi, Illari; Muresu, Narcisa; Saderi, Laura; Piana, Andrea; Farina, Mario; Dessole, Francesco; Virdis, Giuseppe; De Vita, Davide; Madonia, Massimo; Petrillo, Marco; Sotgiu, Giovanni
• Is Part Of: Maturitas. Volume 165(2022)
• Page Start: 104
• Page End: 112
• Publication Date: 2022-11
• Subjects: Anterior vaginal prolapse -- Native tissue repair (NTR) -- Mesh augmentation -- Transvaginal mesh repair -- Cystocele; Climacteric -- Periodicals; Menopause -- Periodicals; Climacteric -- Periodicals; Geriatrics -- Periodicals; Menopause -- Periodicals; Middle Aged -- Periodicals; Climatère -- Périodiques; Ménopause -- Périodiques; Climacterium; Climacteric; Menopause; Electronic journals; Periodicals; 612.66
• DOI: 10.1016/j.maturitas.2022.07.013
• Languages: English
• ISSNs: 0378-5122

Abstract

Highlights: Mesh repair was associated with a higher anatomical cure rate than native tissue repair when the follow-up was up to 24 months. No differences were observed in the risk of re-operation between native tissue repair and mesh augmentation. Pooled risk differences in the incidence of post-surgical and late complications were higher for the mesh repair intervention. Abstract: The aim of the present systematic review and meta-analysis was to compare native tissue repair (NTR) against transvaginal mesh augmentation for the repair of anterior vaginal prolapse. A total of 2289 articles were found but only 27 (24.8 %) were included in the review. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were followed to guide the process of the systematic review and meta-analysis. The quality of the observational studies was evaluated according to the Scottish Intercollegiate Guidelines Network, whereas the quality of randomized control trials (RCT) was assessed by the Cochrane risk-of-bias scale. The mesh repair intervention was associated with a higher anatomical cure rate in comparison with NTR repair when the follow-up was ≤24 months [pooled risk difference (95 % CI): −0.18 % (−0.22 %; 0.13 %); p-value: <0.0001; I2 : 36.0 %]. Studies reporting anatomical failure had similar findings [pooled risk difference (95 % CI): 0.17 % (0.01 %; 0.33 %); p-value: 0.03; I2 : 88.6 %]. No differences in the risk of re-operation were observed between NTR repair and mesh augmentation. Pooled risk differences in the incidence of post-surgical and late complications were higher for the mesh repair intervention [−0.05 % (95 % CI: −0.10 %; 0.00 %) p-value: 0.05; I2 : 68.3 %] [−0.05 % (95 % CI: −0.14 %; 0.03 %) p-value: 0.25; I2 : 82.0 %]. Women who underwent mesh repair reported greater satisfaction than women who underwent NTR [pooled risk difference (95 % CI): −0.07 % (−0.16 %; 0.02 %); p-value: 0.15; I2 : 65.3 %]. In conclusion, mesh repair surgery had higher anatomical cure and satisfaction rates, with no differences in re-operation rate, but had higher post-surgical and late complications in comparison with NTR.