Meta-analysis Of The Effectiveness And Safety Of Paravaginal Repair In The Treatment Of Anterior Vaginal Prolapse

Objective Systematic evaluation of the effectiveness and safety of paravaginal repair in the treatment of anterior vaginal prolapse.Methods Keywords were searched in: CNKI,Wanfang Data,PubMed,ScienceDirect,MEDLINE,Embase,Cochrane Library and China Biomedical Literature Database(CBM).Data up to 31 March 2019 were considered.Clinical studies evaluating all women with anterior vaginal prolapse who underwent paravaginal repair were included.Patients with anterior vaginal prolapse treated by other operation were the control group,but it is not essential.Languages was restricted to Chinese and English.Studies were collected and evaluated according to the inclusion and exclusion criteria.Quality evaluation of methodologies of all included studies were done.And the criteria to the randomized controlled trials were based on the Cochrane bias risk assessment criteria.The Newcastle-Ottawa Scale(NOS)was used for quality assessment of nonrandomized controlled studies.The part of the MINORS score scale was used for quality assessment of non-controlled clinical studies.Meta-analysis of surgery related controlled data were conducted with The Cochrane Collaboration's RevMan 5.3 software,and the single rate meta-analysis of the anatomic recurrence rate was performed using R3.5.3 software.Results A total of 25 studies were included,including 21 non-controlled studies,2randomized controlled trials(RCT),and 2 cohort studies.The publication time was from2001 to 2018.Two of them were randomized controlled trials(RCT),compared anterior colporrhaphy with paravaginal repair;Two were cohort studies,one was compared anterior colporrhaphy with paravaginal repair combied anterior colporrhaphy,the other was compared sacrocolpopexy with sacrocolpopexy combined paravaginal repair.21non-controlled studies were performed paravaginal repair for the treatment of anterior vavginal prolapse.?Meta-analysis results of controlled studies showed that:(1)There was no significant difference in the age,operation time,blood loss,preoperative POP-Qstage(Ba and C points)between the two group(P>0.05)s;(2)The postoperative POP-Q score(Ba point)were significantly better than before in two groups,but there was no significant difference between the two groups(P>0.05).As Ba?-1cm was defined as recurrence,the postoperative recurrence rate of the paravaginal repair group was lower.The difference was statistically significant [P<0.05,OR=0.57(0.33,0.97)].There were few studies on the subjective cure rate,so statistical analysis was infeasible.(3)Complications mentioned in the studies included: urinary retention,stress urinary incontinence,retropubic bleeding,dyspareunia,and mesh exposure.The incidence of dyspareunia showed no significant difference between the two groups;(4)Two studies reported the quality of life scores(POPDI,UDI,POPIQ,UIQ)of patients before and after surgery,and the initial data showed that the postoperative quality of life were better than before.But due to different data presentation methods,it could not be combined for statistical analysis.?A single rate meta-analysis of anatomic recurrence rates showed a recurrence rate of 16%(95% CI: 12% to 22%)after paravaginal repair.Subgroup analysis of surgical methods,the recurrence rate of VPVR,APVR and LPVR is 18%(95% CI: 12% to 26%),17%(95% CI: 4 % to 75%)and 11%(95%CI:6%~20%)respectively,and there were no significant differences among different methods(P>0.05).Conclusion1)The paravaginal repair for the treatment of female anterior vaginal prolapse is effective,and the anatomic recurrence rate of paravaginal repair is low.2)Paravaginal repair is safe,and the common complications include dyspareunia,retropubic bleeding,urine retention,and mesh exposure.Familiarity with pelvic floor anatomy and proficiency in the surgeon's surgical skills are beneficial in avoiding complications.3)Paravaginal repair for the treatment of anterior vaginal prolapse is significant,but pelvic organ prolapse is often associated with each other,isolated operation can not solve all problems.The treatment of prolapse should be based on the location of the defect before surgery,and the best treatment plan should be developed in combination with the patient's condition.4)There are very few randomized controlled trials(RCTs)about paravaginal repair,and the sample size is small,the follow-up time is short,and the effects of other accompanying surgery cannot be completely ruled out.So it is necessary for clinicians tocarry out more high-quality,multi-center randomized controlled trials to confirm the clinical effectiveness of paravaginal repair.