Sacrocolpopexy and sacrohysteropexy outcomes, mesh safety and complications, uterosacral and native-tissue suspension, recurrence after apical repair, pessary and pelvic floor treatment compared with surgery.
This page is written for clinicians and referrers and is not advice for individual patients. If you are a patient, the plain-language page is Prolapse surgery .
Each week the literature is searched for new papers on prolapse and mesh, screened to the few that meet the evidence bar, and each one is verified on PubMed before it is summarised. I read every entry and give one verdict: whether the paper changes what I tell patients or do in theatre, supports current practice, or leaves it unchanged. Papers appear here newest first, grouped by the week they were found, with the study design, the main result and its effect size, and the reason for the verdict. Abstracts are not reproduced; the summaries are my own.
Catch-up digest, 22 September 2026 to 19 October 2026
Seeding run over a longer window, written 19 October 2026
Mesh placed through the abdomen makes apical prolapse less likely to come back than stitch-only repair, and sacrocolpopexy was the most durable operation: network meta-analysis of 58 randomised trials
Systematic review and network meta-analysis of 58 randomised trials (6,846 women) of surgery for primary apical prolapse, comparing vaginal, abdominal and laparoscopic mesh operations with native-tissue (stitch-only) repair as the reference; trials had to report anatomical recurrence at one year or more; searches to 30 June 2025; the integrity of each trial was checked with the TRACT checklist.
Finding
Vaginal, abdominal and laparoscopic mesh repairs all reduced anatomical recurrence compared with native-tissue repair (relative risk 0.59 to 0.66, that is roughly a third to two fifths fewer recurrences); laparoscopic sacrocolpopexy with posterior plication and vaginal mesh lowered subjective recurrence (relative risk 0.22 to 0.51); abdominal sacrocolpopexy had fewer reoperations for recurrence (relative risk 0.40), whereas vaginal mesh had more reoperations for mesh problems (relative risk 5.19); the abstract gives no confidence intervals and no absolute rates.
Supports current practicestrong evidence
It backs sacrocolpopexy as the most durable apical repair and puts numbers on the trade-off he already describes to patients: mesh through the abdomen cuts recurrence by about a third or more, and the mesh penalty in the trials falls on the vaginal route rather than on sacrocolpopexy.
What it means
For the woman choosing between a sacrocolpopexy and a vaginal operation with stitches, this confirms what the prolapse page already says from the Cochrane review: mesh placed through the abdomen makes the prolapse less likely to come back, by about a third to two fifths, and sacrocolpopexy was the most durable of the operations compared.
Reviewed by Mr Jan, .
A more advanced prolapse, previous prolapse surgery and a higher BMI raise the chance of recurrence after surgery for uterovaginal prolapse; age, parity and menopause do not: meta-analysis of 25 studies and consensus
Systematic review and random-effects meta-analysis of 25 studies (14,860 women, median follow-up 24 months) of patient-level risk factors for recurrence after surgery for uterovaginal prolapse, with risk of bias assessed by GRADE; the findings fed a Delphi process at the Global Consensus Conference on primary uterovaginal prolapse in April 2026, with consensus set at 80 per cent agreement.
Finding
Of 16 risk factors identified, 9 could be pooled. Advanced preoperative stage (OR 2.75, 95% CI 1.39 to 5.46), prior prolapse surgery (OR 2.09, 95% CI 1.16 to 3.75) and higher BMI (OR 1.10 per unit, 95% CI 1.06 to 1.15) each raised the odds of recurrence, while age, diabetes, smoking, parity, menopause and preoperative oestrogen use showed no significant association; where data were insufficient, expert consensus added levator ani avulsion, an enlarged genital hiatus and connective-tissue disorders as risk factors.
Supports current practicemoderate evidence
It gives him pooled figures for the three factors he already uses when counselling about recurrence and, usefully, clears age, parity and menopause as predictors; the pooled factors come mostly from observational studies.
What it means
For the woman asking whether her prolapse will come back after surgery, three things raise the odds: a more advanced prolapse to begin with (nearly three times the odds), a previous prolapse operation (about twice) and a higher weight (about 10 per cent more for each unit of BMI), while age, the number of births, the menopause and vaginal oestrogen beforehand made no measurable difference.
Reviewed by Mr Jan, .
Overactive bladder symptoms settle in about three in five women after prolapse surgery, and in about three in four after anterior or apical repair: meta-analysis of 24 studies
Systematic review and meta-analysis of 24 comparative studies, randomised and observational (7,739 women, 7,095 analysed), of women with prolapse of stage II or worse and validated overactive bladder outcomes at least three months after surgery; searches to 31 December 2024; risk of bias assessed with Cochrane RoB 2.0 and Newcastle-Ottawa, certainty with GRADE.
Finding
Pre-existing overactive bladder resolved in 58.0% (95% CI 55.9% to 60.1%; I2 83.9%), about three in five women, with no difference between vaginal, laparoscopic or robotic and abdominal routes (p=0.62) or between mesh and native tissue (p=0.48); anterior or apical repair resolved it in 75.8% (95% CI 73.2% to 78.3%), about three in four, against 28.3% (95% CI 20.1% to 37.9%), fewer than one in three, after isolated posterior repair (p<0.001); new overactive bladder after surgery ranged from 0% to 14.3% in the six studies that reported it.
Supports current practicemoderate evidence
It supports telling women with urgency symptoms that anterior or apical repair, including sacrocolpopexy, improves them in most cases and that a posterior repair alone usually will not; heterogeneity is high and most studies are observational.
What it means
For a woman with prolapse who also has urgency or frequency, he can say that the bladder symptoms settle after prolapse surgery in about 3 in 5 women overall, in about 3 in 4 when the front wall or the top of the vagina is repaired, and in fewer than 1 in 3 after a repair of the back wall alone, with no sign that mesh, or the robotic against the vaginal route, changes that.
Reviewed by Mr Jan, .
Every paper on this site's evidence pages is also available as open data at /evidence/papers.json. The search and screening rules are on the evidence index.
Last reviewed .Reviewed by Mr Haider Jan, Consultant Gynaecologist.
For patients: Prolapse surgery
The plain-language page on what the condition is, how I assess it and the choices, written for the women I see.
