EC Gynaecology

Background: Pelvic organ prolapse is a prevalent condition affecting up to 40% of women globally. Sacrocolpopexy remains the gold-standard surgical treatment, traditionally utilising synthetic materials such as polypropylene, however growing interests in biologic grafts have raised questions about their relative performance. This systematic review and meta-analysis compares objective (POP-Q stage 0) and clinical (POP-Q stage 1) cure rates between synthetic and biologic grafts 12 months post sacrocolpopexy.

Methods: A systematic search of PubMed and Scopus was conducted in line with PRISMA guidelines. Studies comparing POP-Q outcomes at 12 months post sacrocolpopexy were included. Data extraction was performed, and a meta-analysis was conducting using a DerSimonian and Laird random-effects model, reporting outcomes as odds ratios (OR) and 95% confidence intervals (CI).

Results: Five studies comprising 600 participants (304 synthetic, 296 biologic) met the inclusion criteria. Among three studies reporting objective cure, 81% of biologic and 77.4% of synthetic graft recipients demonstrated successful outcomes, with no significant difference (OR 0.563; 95% CI 0.121-2.617). Four studies reported clinical cure, with success rates of 66.7% and 68.5%, respectively (OR 0.695; 95% CI 0.263-1.840). Sensitivity analysis demonstrated significantly higher clinical cure rates in the synthetic cohort (OR 0.465; 95% CI 0.254-0.854).

Conclusion: While synthetic and biologic grafts yielded comparable objective cure rates, sensitivity analysis suggested superior clinical outcomes with synthetic materials. The heterogeneity of biologic grafts complicates direct comparisons, highlighting the need for standardized outcome reporting and further research to guide graft selection in sacrocolpopexy.

 Keywords: Prolapse; Sacrocolpopexy; Mesh; Biologics; Graft; Urogynaecology

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