A Cochrane review [Abstract] 1 included 26 eligible trials with a total of 2271 participants. 13 involved the comparison of laparoscopic with open colposuspension. There was little difference between laparoscopic colposuspension using sutures and open colposuspension for subjective cure within 18 months (RR 1.04, 95% CI 0.99 to 1.08; 6 trials, n=755 women; high-quality evidence). There were fewer perioperative complications (RR 0.67, 95% CI 0.47 to 0.94; 11 trials, n=1369 women; low-quality evidence), less postoperative pain and shorter hospital stay for laparoscopic compared with open colposuspension, however, laparoscopic colposuspension had nonsignificantly higher rates of bladder perforations (RR 1.72, 95% CI 0.90 to 3.29; 10 trials, n=1311 women).
Nine studies compared laparoscopic colposuspension with newer midurethral sling procedures. There was no difference between laparoscopic colposuspension using sutures and tension-free vaginal tape (TVT) for subjective cure within 18 months (RR 1.01, 95% CI 0.88 to 1.16; 4 trials, n=256; low-quality evidence) or between laparoscopic colposuspension using mesh and staples and TVT (RR 0.71, 95% CI 0.55 to 0.91; 1 trial, n=121). There were no significant differences for postoperative voiding dysfunction and perioperative complications. Laparoscopic colposuspension had a significantly longer operation time and hospital stay. Significantly higher subjective and objective one-year cure rates were found for women randomised to two paravaginal sutures compared with one suture in a single trial.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).
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