Systematic review and appraisal of clinical practice guidelines on pelvic organ prolapse using the AGREE II tool
Abstract
Aims: To systematically evaluate the content and quality of national and international clinical guidelines on pelvic organ prolapse (POP). Methods: We searched medical databases and organizations websites, to identify national and international guidelines on diagnosis and management of POP. Five authors independently assessed guidelines using the validated AGREE II tool. Its six domains include (1) scope and purpose, (2) stakeholder involvement, (3) rigor of development, (4) clarity of presentation, (5) applicability, and (6) editorial independence. Results: Eight guidelines met the inclusion criteria. Three hundred and thirteen different recommendations were identified. One hundred and ninety‐nine recommendations were comparable across guidelines. Thirty‐one recommendations were not supported by research evidence. Assessment by history and physical examination using the POP quantification system and consideration of imaging were recommendations featuring in all guidelines. Conservative treatment recommendations namely pelvic floor muscle training and vaginal pessaries were also found in all guidelines. Regarding surgical management, patient counseling, treating only symptomatic POP, consideration of apical fixation during surgical treatment, and use of biological or synthetic implants in recurrent cases were recommendations in all guidelines. Overall, the highest median scores were in the domains “scope and purpose” and “rigor of development”. The lowest median score was for applicability (28.3%). Although the median score of “editorial independence” was high (85.4%), variability was also substantial (interquartile range: 12.5–100). Conclusion: We identified variations in quality and deficiencies in certain areas, especially “applicability” and “editorial independence.” Improvements in these key domains may enhance the quality and clinical impact of clinical practice guidelines.
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In a systematic review of clinical practice guidelines on POP, 313 recommendations were examined, of which 199 were comparable across guidelines but 31 were found to be unsupported by research evidence.
“In a systematic review of clinical practice guidelines on POP 313 recommendations were examined of which 199 were comparable across guidelines but 31 were found to be unsupported by research evidence [23].”
From How Can We Improve the Assessment and Indifferent Outcomes From Pelvic Organ Prolapse Management From Conservative and Surgical Therapies? ICI‐RS 2025 (2026) · cites this paper as [23]
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- Authors
- Tsiapakidou, S., Nygaard, C. C., Falconi, G., Pape, J., Betschart, C., Doumouchtsis, S. K., & CHORUS: An International Collaboration for Harmonising Outcomes, R. A. S. I. U. A. W. H. (.-C. O.
- Affiliations
- Aristotle University of Thessaloniki (GR)
- St Helier Hospital (GB)
- Ospedale San Bortolo (IT)
- University Hospital Zurich (CH)
- St George's, University of London (GB)
- Corresponding author
- Tsiapakidou, Sofia
- ORCID
- Venue
- Neurourology and Urodynamics
- Publisher
- Wiley
- Published
- 2021-06-08
- Volume
- 40
- Issue
- 6
- Pages
- 1402-1413
- ISSN
- 0733-2467 (ISSN-L)
- 1520-6777
- OpenAlex
- W3168770295
- Cited by
- 9
- References
- 37
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 4 · 2021: 1
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurourology and Urodynamics (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- pelvic organ prolapse, guideline quality, AGREE II, guideline development rigor, applicability, editorial independence, pelvic floor muscle training, pessary
- MeSH terms
- Female, Humans, Databases, Factual, Practice Guidelines as Topic, Pelvic Organ Prolapse
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