Research in context
Evidence before this study
We searched the Cochrane Database, Database of Abstracts of Reviews of Effectiveness, and Health Technology Assessment database for systematic reviews of the surgical management of stress urinary incontinence (incontinence) and pelvic organ prolapse (prolapse) in women. We searched MEDLINE for observational studies of outcomes after surgical management of incontinence and prolapse published in English from 2000 onwards with search terms urinary incontinence, stress [surgery], prolapse [surgery], or pelvic organ prolapse [surgery] and treatment outcome, intraoperative complications, or postoperative complications. Finally, we searched for relevant guidance from professional bodies, health-care regulators, and UK governmental committees. Searches were conducted over 2015 and updated in April, 2016.
Existing trials on the surgical management of prolapse are small and of low or moderate quality. Evidence on long-term effectiveness and complications after surgical treatment of both incontinence and prolapse is scarce, and high-quality evidence from observational studies is limited.
Added value of this study
We report the first large-scale robust observational study of outcomes after surgical management of both incontinence and prolapse to our knowledge. We use high-quality administrative data with complete population coverage to examine long-term (up to 5 years) effectiveness and complications after specific mesh and comparable non-mesh procedures.
Implications of all the available evidence
Our data support the use of mesh procedures for incontinence, although further research on longer term outcomes would be beneficial. Mesh procedures for anterior and posterior compartment prolapse (when done as an isolated, first repair) cannot be recommended for primary prolapse repair. Our data do not clearly favour any particular vault repair procedure. New trials of mesh surgery for prolapse (PROSPECT) and incontinence (SIMS) are underway and will add to the available evidence, as will longer term follow-up of existing trial cohorts and ongoing judicious analysis of routinely available health-care data to monitor outcomes of routine clinical practice.