CESA/VASA 55 MATERIALS AND METHODS Data sources A comprehensive literature search was performed together with a biomedical information specialist. Electronic searches were performed in PubMed (including MEDLINE), Embase, Web of Science Core Collection and the Cochrane Library (Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials). In addition, the trial registers clinicaltrials.gov and the International Clinical Trials Registry Platform (ICTRP) were searched. We applied no restriction on publication date; all studies published till 17th of September 2021 (search date) were eligible. A grey literature search, consisting of reference lists of the eligible studies and Google Scholar, was conducted. Our search strategy combined Medical Subject Headings (MeSH) for PubMed and the Cochrane Library/ Emtree terms for Embase and free text words using the following search strategy: (CONCEPT 1: condition/population) AND (CONCEPT 2: Intervention). The search was expanded using the snowballing method applied to the references of retrieved papers. The EndNote X9 desktop version (Clarivate Analytics, Philadelphia, PA, USA) was used to list search results and to eliminate duplicates.112 Further duplicate elimination and reference screening on titles and abstracts was performed with Rayyan (Qatar Computing Research Institute, Doha, Qatar) by two independent reviewers (ASP and GP). The selected potentially eligible studies were assessed as full-text papers using Rayyan by the same reviewers based on the eligibility criteria. In case of discrepancies, the eligibility of studies was discussed with the senior review authors (JD). A consensus was reached for all assessed studies. Main outcome measures The primary outcome measures were improvement in prolapse and urinary symptoms, both subjective and objective. The secondary outcomes included data on surgical safety and reintervention rates for complications and POP and/or UI recurrence. Eligibility criteria All types of studies restricted to English and German language (as the procedure was developed in Germany)107, reporting on women with apical prolapse and/or UI undergoing the CESA or VASA procedure, were included in this analysis. No search filters were used. The PICO format was used to identify studies and for data extraction.113 Participants were women with urge incontinence, mixed incontinence, and/or apical prolapse. The intervention was the surgical technique referred to as CESA or VASA. Comparisons were currently available pharmacological and surgical modalities. Outcomes were urinary incontinence symptoms and/or prolapse symptoms and/or prolapse and/or urinary incontinence on the postoperative assessment.
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