Sofia Tsiapakidou1, Christiana Campani Nygaard2,3, Janna Pape4, Thais R de Mattos Lourenço5, Gabriele Falconi6, Cornelia Betschart4, Stergios K Doumouchtsis2,7,8. 1. 1st Department of Obstetrics and Gynecology, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 2. Department of Obstetrics and Gynaecology, Epsom and St Helier University Hospitals NHS Trust, London, UK. 3. Department of Obstetrics and Gynecology, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil. 4. Department of Gynecology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland. 5. Department of Urogynecology, Discipline of Gynecology, Hospital das Clínicas da Faculdade de Medicina da USP, Universidade de São Paulo, São Paulo, Brazil. 6. Department of Surgical Sciences, Complex Operative Unit of Gynecology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy. 7. St George's University of London, London, UK. 8. School of Medicine, American University of the Caribbean, Pembroke Pines, FL, USA.
Abstract
OBJECTIVE: To systematically evaluate the content and quality of national and international guidelines on vaginal mesh procedures for pelvic organ prolapse (POP). METHODS: We searched PubMed, Medline, Web of Science, and ScienceDirect from inception to March 2020 and organizations' websites. The quality of the guidelines was assessed independently by six appraisers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. RESULTS: Five guidelines were included. Most guidelines recommended individualized treatments, clinical observation, and conservative treatment for asymptomatic women discouraging the use of mesh. Vaginal pessary and pelvic floor muscle training are unanimously considered effective treatments. Only two guidelines recommended weight loss. Each guideline recommended patient counseling supported by data on success rates and complications. Most guidelines highlighted the importance of a specialist experienced surgeon, multidisciplinary teams, and national/international registries. All guidelines highlighted potential benefits of the use of mesh and reported possible complications. The overall quality rating ranged between 4.2 and 6.3, suggestive of moderate to high quality. The highest mean score (92.5%) pertained to "Scope and Purpose" and "Clarity of Presentation", and the lowest to "Editorial Independence" (18%). Three out of five guidelines were "strongly recommended" by the appraisers. CONCLUSION: Although most guidelines were of moderate to high quality, methodological applicability, stakeholder involvement, and editorial independence were domains with low scores.
OBJECTIVE: To systematically evaluate the content and quality of national and international guidelines on vaginal mesh procedures for pelvic organ prolapse (POP). METHODS: We searched PubMed, Medline, Web of Science, and ScienceDirect from inception to March 2020 and organizations' websites. The quality of the guidelines was assessed independently by six appraisers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. RESULTS: Five guidelines were included. Most guidelines recommended individualized treatments, clinical observation, and conservative treatment for asymptomatic women discouraging the use of mesh. Vaginal pessary and pelvic floor muscle training are unanimously considered effective treatments. Only two guidelines recommended weight loss. Each guideline recommended patient counseling supported by data on success rates and complications. Most guidelines highlighted the importance of a specialist experienced surgeon, multidisciplinary teams, and national/international registries. All guidelines highlighted potential benefits of the use of mesh and reported possible complications. The overall quality rating ranged between 4.2 and 6.3, suggestive of moderate to high quality. The highest mean score (92.5%) pertained to "Scope and Purpose" and "Clarity of Presentation", and the lowest to "Editorial Independence" (18%). Three out of five guidelines were "strongly recommended" by the appraisers. CONCLUSION: Although most guidelines were of moderate to high quality, methodological applicability, stakeholder involvement, and editorial independence were domains with low scores.