Sacrocolpopexy compared with transvaginal mesh surgery: a systematic review and meta-analysis.

<bold>Background: </bold>The use of mesh is controversial in the treatment of female pelvic organ prolapse.<bold>Objectives: </bold>To systematically review the outcomes of sacrocolpopexy compared with transvaginal mesh surgery and to provide evidence-based suggestions.<bold>Search Strategy: </bold>The MEDLINE, EMBASE, Cochrane Library and clinicaltrials.gov databases were searched on 21 November 2018.<bold>Selection Criteria: </bold>Randomised controlled trials and prospective and retrospective cohort studies were included.<bold>Data Collection and Analysis: </bold>Data were extracted by one reviewer and examined by a second reviewer for accuracy. Odds ratios and 95% CI were calculated using random-effects models.<bold>Main Results: </bold>Twenty comparative studies were included. The meta-analysis was performed with subgroups. The summary odds ratios of the randomised controlled group were 1.84 (95% CI 0.79-4.29, I2  = 75%) for anatomical success, 1.41 (95% CI 0.47-4.24, I2  = 38%) for subjective success, 0.42 (95% CI 0.18-0.98, I2  = 0%) for mesh complications, 0.61 (95% CI 0.20-1.91, I2  = 0%) for prolapse reoperation and 0.44 (95% CI 0.23-0.88, I2  = 0%) for de novo dyspareunia. The mean differences were 0.77 (95% CI 0.31-1.23, I2  = 66%) for total vaginal length and -1.28 (95% CI -2.00 to -0.55, I2  = 66%) for point C after surgery.<bold>Conclusions: </bold>Very-low-quality evidence indicated that the anatomical and subjective success rates of sacrocolpopexy were similar to those of transvaginal mesh surgery; sacrocolpopexy might be more beneficial than transvaginal mesh surgery in terms of mesh-related complication rates, prolapse recurrence and de novo dyspareunia. However, additional high-quality randomised trials with long-term follow-up durations are needed.<bold>Tweetable Abstract: </bold>Sacrocolpopexy is beneficial after surgical anatomical changes and has decreased rates of mesh-related complications and dyspareunia. [ABSTRACT FROM AUTHOR]