Reviewer ’s report  
 
Title:  Predictors of persistent stress urinary incontinence after transvaginal mesh repair.  
 
Version: 1 Date: 21 May 2018 
 
Reviewer:  Xavier  Fritel  
 
Reviewer’s report:  
 
Abstract:  
 
You need to define in the abstract what is a "high urinary flow"  
 
 
Background :  
 
The reported rate for the prevalence of prolapse (50%) is well overdone and not supported by 
evidence. The paper cited here (Digesu BJOG) does not specify the prevalence of POP. Please 
correct or delete.  
 
The uterus or the rectocele may also contribute to urinary obstruction.  
 
I am not aware of any relationship between SUI and "weakness of the pelvic floor muscles". It is 
uncertain that SUI and POP share the same pathophysiology.  
 
Authors should cite the exis ting guidelines on the subject, for example: Le Normand et al. 
Clinical Practice Guidelines: Synthesis of the guidelines for the surgical treatment of primary 
pelvic organ prolapse in women by the AFU, CNGOF, SIFUD -PP, SNFCP, and SCGP. J 
Gynecol Obstet Hum  Reprod 2017  
 
I am not convinced that a method to select women who will benefit from an additional SUI 
procedure during POP repair has never been validated. So, I don't understand what means 
"…patients should be carefully selected…"  
 
 
Methods  
 
Please indicate the definitions of "cystoceles", "uterine prolapse", and "vault prolapse". Please 
give a definition for POP stages.  
 
Please explain why no uterine prolapse were included, did all women had a previous 
hysterectomy?  
 
How persistent SUI was defined?  
 
Discussion  
 
The main limitation of this analysis concerns the practical consequences: if the pre -operative risk 
factors identified by the authors had been used to decide on the surgical procedures, what would 
have been the changes, how many women would have benefited from a MUS, and what would 
the results have been? This point deserves to be discussed.  
 
 
Conclusion  
 
The last sentence of the conclusion is not supported by the results of the study, because the 
authors have not demonstrated that taking into account the ident ified risk factors modifies the 
surgical procedures and improves the results.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any  stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
NONE  
 
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