Case study : a patient-clinician collaboration that identified and prioritized evidence gaps and stimulated research development

Copyright © 2013 Elsevier Inc. All rights reserved.Peer reviewedPostprin

Electrical stimulation with non-implanted devices for stress urinary incontinence in women

The authors would like to thank Luke Vale, Imran Omar, Sheila Wallace and Suzanne MacDonald at the Cochrane Incontinence Group for their support. We would also like to thank Mette Frahm Olsen, Gavin Stewart, Miriam Brazelli, Anna Sierawska, and Beatriz Gualeo for help with translations.Peer reviewedPublisher PD

Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse

The original publication is available at www.springerlink.comPeer reviewedPostprin

Traditional suburethral sling operations for urinary incontinence in women

Funding Information: We are grateful to Adrian Grant, Jonathan Cook, Aldemar Araujo Castro, and several anonymous peer-referees for assistance and valuable comments on this and previous versions of the review. Sheila Wallace provided support for each version of the review as well as for this update and in the classification and identification of new studies. Fiona Stewart assisted with rewriting the effects of interventions section, conversion of incontinence to continence outcomes, and related changes in 'Summary of findings' tables. The review was originally conceived and conducted by Carlos CB Bezerra and Homero Bruschini. An earlier version of this review was completed as part of a project to add brief economic commentaries to Cochrane Incontinence's Reviews on surgery for urinary incontinence in women (Dean 2017). This project was supported by the National Institute for Health Research (NIHR) via the Cochrane Review Incentive Scheme 2016.Peer reviewedPublisher PD

Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review

Introduction and hypothesis A previous version of the Cochrane review for prolapse surgery in 2008 provided two conclusions: abdominal sacrocolpopexy had lower recurrent vault prolapse rates than sacrospinous colpopexy but this was balanced against a longer time to return to activities of daily life. An additional continence procedure at the time of prolapse surgery might be beneficial in reducing post-operative stress urinary incontinence; however, this was weighed against potential adverse effects. The aim of this review is to provide an updated summary version of the current Cochrane review on the surgical management of pelvic organ prolapse

Surgical management of pelvic organ prolapse in women (Withdrawn Paper. 2007, art.no. CD004014)

Backgroun

RENORMALIZATION IN COMPLEX DYNAMICS (Applications of Renormalization Group Methods in Mathematical Sciences)

BackgroundConcerns have been raised about the safety of surgery for stress urinary incontinence and pelvic organ prolapse using transvaginal mesh. We assessed adverse outcomes after first, single mesh procedures and comparable non-mesh procedures.MethodsWe did a cohort study of women in Scotland aged 20 years or older undergoing a first, single incontinence procedure or prolapse procedure during 1997–98 to 2015–16 identified from a national hospital admission database. Primary outcomes were immediate postoperative complications and subsequent (within 5 years) readmissions for later postoperative complications, further incontinence surgery, or further prolapse surgery. Poisson regression models were used to compare outcomes after procedures carried out with and without mesh.FindingsBetween April 1, 1997, and March 31, 2016, 16 660 women underwent a first, single incontinence procedure, 13 133 (79%) of which used mesh. Compared with non-mesh open surgery (colposuspension), mesh procedures had a lower risk of immediate complications (adjusted relative risk [aRR] 0·44 [95% CI 0·36–0·55]) and subsequent prolapse surgery (adjusted incidence rate ratio [aIRR] 0·30 [0·24–0·39]), and a similar risk of further incontinence surgery (0·90 [0·73–1·11]) and later complications (1·12 [0·98–1·27]); all ratios are for retropubic mesh. During the same time period, 18 986 women underwent a first, single prolapse procedure, 1279 (7%) of which used mesh. Compared with non-mesh repair, mesh repair of anterior compartment prolapse was associated with a similar risk of immediate complications (aRR 0·93 [95% CI 0·49–1·79]); an increased risk of further incontinence (aIRR 3·20 [2·06–4·96]) and prolapse surgery (1·69 [1·29–2·20]); and a substantially increased risk of later complications (3·15 [2·46–4·04]). Compared with non-mesh repair, mesh repair of posterior compartment prolapse was associated with a similarly increased risk of repeat prolapse surgery and later complications. No difference in any outcome was observed between vaginal and, separately, abdominal mesh repair of vaginal vault prolapse compared with vaginal non-mesh repair.InterpretationOur results support the use of mesh procedures for incontinence, although further research on longer term outcomes would be beneficial. Mesh procedures for anterior and posterior compartment prolapse cannot be recommended for primary prolapse repair. Both vaginal and abdominal mesh procedures for vaginal vault prolapse repair are associated with similar effectiveness and complication rates to non-mesh vaginal repair. These results therefore do not clearly favour any particular vault repair procedure