Evaluation of guidelines on the use of vaginal mesh implants for pelvic organ prolapse using the AGREE II instrument

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.

Evaluation of clinical practice guidelines (CPG) on the management of female chronic pelvic pain (CPP) using the AGREE II instrument

“…Our findings are consistent with other studies that noted the Applicability, Editorial Independence and Stakeholder Involvement domains as areas of improvement for future guideline development [7,8,10,16].…”

“…This systematic review reflects variations in guideline recommendations and the poor quality of guideline development. Similar results were found in studies critically appraising the quality of guidelines including BPS, endometriosis, obstetric perineal lacerations and the use of transvaginal mesh implants in prolapse [7,8,10,16]. Challenges of guideline development are not unique to a specific area of medicine but represent a generic issue arising from a lack of standardization.…”

“…This study is part of a wider project for establishing core outcome sets (COS) in CPP. We followed a methodological approach implemented successfully by previous studies by CHORUS working groups appraising the quality of clinical guidelines in various areas of gynaecology [7,8,10].…”

“…Guidelines are developed using standardized methods and processes including: engaging stakeholder groups, identifying, quality assessment and synthesis of research evidence as well using consensus methods to derive robust guideline recommendations. The methodological quality of guidelines has been inconsistent [7][8][9][10].…”

Systematic review and appraisal of clinical practice guidelines on pelvic organ prolapse using the AGREE II tool

“…In addition to its originality, our study followed a robust search strategy and methodology previously followed by our working groups in a number of similar studies. 11,12,16…”