Effect of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse: 5-year results of a randomized clinical trial

Contemporary Use and Techniques of Laparoscopic Sacrocolpopexy With or Without Robotic Assistance for Pelvic Organ Prolapse

“…Moreover, the only vaginal surgery with reported long-term cure rates comparable with those for laparoscopic and robotic sacrocolpopexy is the vaginal mesh hysteropexy, which was removed from the market by the U.S. Food and Drug Administration in 2019. 7 We agree with the authors' conclusion from that study, which states that the vaginal mesh hysteropexy procedure should be made available to patients. However, unless that happens, the laparoscopic sacrocolpopexy with or without robotic assistance will remain the minimally invasive approach to prolapse repair with the best reported long-term cure rates as defined by the latest composite definitions.…”

“…3 , 4 However, when scrutinized through rigorous research methods, these traditional native tissue techniques have demonstrated rather poor objective and subjective success rates. 5 , 6 Use of lightweight polypropylene mesh in the form of a sacrospinous hysteropexy recently demonstrated lower composite failure rates compared with vaginal hysterectomy plus native tissue repair 7 for patients with symptomatic uterovaginal prolapse, but the U.S. Food and Drug Administration removed these products from the market in 2019 before these long-term data became available. This removal of the transvaginal mesh option has resulted in sacrocolpopexy being the predominant approach for mesh-augmented prolapse repair.…”

Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings

“…At 5 years, this study’s parent SUPeR trial found that the only anatomic POP-Q measure that differed between hysteropexy versus hysterectomy with uterosacral ligament suspension was total vaginal length with an average of 0.9 cm longer length in the hysteropexy arm. Neither the anterior compartment nor apical POP-Q points differed between groups 8 . It might be assumed that these latter POP-Q points, which are highly correlated with one another in women with severe prolapse, 17 would have the greatest effect on the continence mechanisms, reflecting straightening of the anterior vagina and decreasing urethral resistance or kinking 18 .…”

“…Neither the anterior compartment nor apical POP-Q points differed between groups. 8 It might be assumed that these latter POP-Q points, which are highly correlated with one another in women with severe prolapse, 17 would have the greatest effect on the continence mechanisms, reflecting straightening of the anterior vagina and decreasing urethral resistance or kinking. 18 Given that the anterior vaginal wall POP-Q measurements remained similar between groups at 5 years, this variable does not explain the differential urinary outcomes between prolapse repair groups demonstrated in the current study.…”

“…This is a secondary analysis of the SUPeR trial, a randomized controlled trial that compared treatment success after transvaginal sacrospinous hysteropexy with graft (Uphold LITE) (hysteropexy group) and vaginal hysterectomy using uterosacral ligament suspension (hysterectomy group), in women with symptomatic uterovaginal prolapse beyond the hymen. Full protocol details as well as 3- and 5-year outcomes have been published 8–10 . The protocol did not specify treatment of SUI, leaving the decision to the surgeon’s discretion.…”