Among the many surgical treatments for pelvic organ prolapse (POP), better results
can be achieved with the use of vaginal implants. However, owing to perceived complications,
vaginal implant surgeries have been restricted or banned in many countries.To assess
the real value of vaginal implants in POP surgery and compare the safety and efficacy
of operations with and without implants.A systematic search was performed in three
medical databases. Randomised controlled trials and observational studies comparing
the safety and efficacy of vaginal POP surgery with implants versus native tissue
were included. Safety outcomes were defined as different types of complications (functional
and non-functional) and reoperations for complications. Efficacy outcomes were parameters
of anatomical success and the rate of reoperations due to recurrence. A multivariate
meta-analysis framework was used to estimate pooled odds ratios (ORs) with confidence
intervals (CIs) with simultaneous control for study correlations and estimation of
multiple correlated outcomes.We included 50 comparative studies in the analysis. Rates
of reoperation for complications (OR 2.15, 95% CI 1.20-3.87), vaginal erosion (OR
14.05, 95% CI 9.07-21.77), vaginal bleeding (OR 1.67, 95% CI 1.25-2.23), and de novo
stress urinary incontinence (OR 1.44, 95% CI 1.18-1.75) were significantly higher
in the implant group. Rates of anatomical success (OR 3.22, 95% CI 2.06-5.0) and reoperation
for recurrence (OR 0.55, 95% CI 0.36-0.85) were superior in the implant group.POP
surgeries with vaginal implants are more effective than surgeries without implants,
with acceptable complication rates. Therefore, the complete prohibition of implants
for POP surgeries should be reconsidered.We compared vaginal surgery with and without
implants for repair of pelvic organ prolapse. Despite higher complication rates, vaginal
implants provide better long-term results overall than surgery without implants.
