Surgical Strategies for Apical Pelvic Organ Prolapse: A Systematic Review and Network Meta-Analysis
In brief
Mesh repairs cut prolapse recurrence by 34% to 41% versus native tissue surgery
Across 58 randomized trials involving 6,846 patients, vaginal, abdominal and laparoscopic mesh repairs were associated with 34% to 41% less anatomic recurrence than native tissue repair. Abdominal sacrocolpopexy had fewer recurrence-related reoperations, but vaginal mesh had more mesh-related reoperations. The findings show a durability-safety tradeoff, so individual risks and preferences remain important when choosing surgery.
- Journal
- International urogynecology journal (Q2)
- Published
- 23 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Tran T T Nguyen, Pouria Aryan, Mahshid Taheri, Ben Willem Mol, Marie Fidela R Paraiso, Jennifer Phung, et al.
- PMID
- 42776189
- DOI
- 10.1007/s00192-026-06857-4
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 27 September 2026).
Abstract
INTRODUCTION AND HYPOTHESIS: Comparative effectiveness of surgical approaches to apical pelvic organ prolapse (POP) remains uncertain, particularly regarding recurrence, reoperation and mesh-related outcomes over the available follow-up. The objective was to compare the effectiveness and safety of surgical treatments for primary apical pelvic organ prolapse (POP) using a systematic review and network meta-analysis of randomised controlled trials (RCTs). METHODS: Comprehensive searches were conducted in Web of Science, Scopus, Embase, Medline, Cochrane Library, WHO, and ICTRP databases from inception to 30 June 2025. English-language RCTs comparing surgical interventions for apical POP, alone or with other compartment repairs, were included if they reported anatomical recurrence after ≥ 1-year follow-up. Studies on non-surgical interventions were excluded. The primary outcome was anatomical recurrence; secondary outcomes included subjective recurrence, reoperation rates and mesh complications. Risk of bias was assessed using the Cochrane tool, and study integrity was evaluated with the Trustworthiness in Randomised Controlled Trials checklist. A random-effects network meta-analysis (NMA; NMAstudio 2.0) was performed, grouping interventions by clinical similarity. Native tissue repair (NTR) served as the reference. RESULTS: Fifty-eight RCTs (6,846 participants) were included. Vaginal, abdominal and laparoscopic mesh repairs significantly reduced anatomical recurrence versus NTR (relative risk 0.59-0.66). Vaginal mesh and laparoscopic sacrocolpopexy with posterior plication lowered subjective recurrence (relative risk 0.22-0.51). Abdominal sacrocolpopexy was associated with fewer recurrence-related reoperations (relative risk 0.40), whereas vaginal mesh had higher mesh-related reoperations (relative risk 5.19). CONCLUSIONS: Mesh-augmented vaginal, laparoscopic and abdominal repairs reduce prolapse recurrence compared with NTR but carry increased mesh-related risks. Sacrocolpopexy was associated with favourable anatomical durability for apical POP.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.