To conduct a comprehensive evaluation of the objective and subjective success rates and consequences of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP) was the aim of the study. The study included randomized controlled trials and comparative investigations of procedures with or without hysterectomy, such as abdominal apical reconstruction using open, laparoscopic, or robotic techniques, as well as vaginal apical reconstructions, from 2,665 records. Transvaginal mesh repairs, off-the-shelf goods, surgeries without apical suspension, and follow-up of less than 6 months were all eliminated. The relative risk (RR) method was used to calculate the influence of each surgical operation on each outcome. When possible, a meta-analysis was performed for each outcome and comparison to pool the RRs. When necessary, meta-regression and bias tests were carried out. The GRADE quality assessment system and PRISMA reporting were employed. The review comprised 62 publications and 50 studies in the meta-analyses. There was variation in the quality of the studies, the procedures utilized, and the outcomes reported. The average period of follow-up was 1–5 years. Vaginal suspensions were associated with a greater risk of apical anatomic recurrence than sacrocolpopexy, but minimally invasive sacrocolpopexy was associated with a lower risk of total and posterior anatomic recurrence than open sacrocolpopexy. Different vaginal methods, as well as hysterectomy and suspension vs hysteropexy, showed comparable anatomic results.

Despite differences in anatomic results, subjective outcomes and complications for apical POP operations were similar at 1–5 years. Standardization of outcome reporting and longer-term comparison research are badly needed.