A Randomized Trial of Vaginal Surgery for Uterovaginal Prolapse: Vaginal Hysterectomy with Native Tissue Vault Suspension vs. Mesh Hysteropexy Suspension

The primary purpose of this randomized clinical trial was to compare the effectiveness and safety of two transvaginal apical suspension strategies for uterovaginal prolapse: a mesh augmented hysteropexy versus vaginal hysterectomy and uterosacral ligament suspension (USLS). Postmenopausal women requesting surgery for symptomatic uterovaginal prolapse were randomized to receive one of the procedures and were then followed at 6-month intervals for 60 months. The primary treatment failure composite outcome (retreatment of prolapse, prolapse beyond the hymen, or prolapse symptoms) was evaluated with survival modeling. The study found that sacrospinous hysteropexy with graft resulted in a lower composite failure rate than vaginal hysterectomy after 5 years of follow-up.