Sacrospinous Hysteropexy With Mesh vs Vaginal Hysterectomy for Treatment of Uterovaginal Prolapse
Charles W. Nager, Anthony G. Visco, Holly E. Richter, Charles R. Rardin, Kate Meriwether, Heidi S. Harvie, Halina M. Zyczynski, Marie Fidela R. Paraiso, Donna Mazloomdoost, Amaanti Sridhar, Sonia Thomas, , Cassandra Carberry, B Star Hampton, Nicole Korbly, Ann S Meers, Deborah L Myers, Vivian W Sung, Kyle Wohlrab, Matthew Barber, Cecile Ferrando, Marie Fidela R Paraiso, Annette Graham, Ly Pung, Beri Ridgeway, Cindy Amundsen, Acacia Harris, Amie Kawasaki, Shantae McLean, Nazema Siddiqui, Anthony G Visco, Alison Weidner, Gouri B Diwadkar, Keisha Y Dyer, Linda M Mackinnon, Gisselle Zazueta-Damian, Donna Mazloomdoost, Katrina Burson, Marie Gantz, Kendra Glass, Kimberly McMillian, Amanda Shaffer, Amaanti Sridhar, Dennis Wallace, Ryan Whitworth, Alicia Ballard, Kathy Carter, David Ellington, Ryanne Johnson, Sunita Patel, Holly E Richter, R Edward Varner, Robin Willingham, Velria Willis, Kimberly Ferrante, Kyle Herrala, Emily S Lukacz, Charles Nager, Gena Dunivan, Peter Jeppson, Yuko Komesu, Rebecca G Rogers, Lorraine Flick, Heidi S Harvie, Michelle Kinglee, Ariana Smith, Michael Bonidie, Judy Gruss, Pamela Moalli, Jonathan Shepherd, Gary Sutkin, Halina M ZyczynskiImportance
Vaginal hysterectomy with suture apical suspension (hysterectomy) is commonly performed for uterovaginal prolapse, and a vaginal sacrospinous hysteropexy with graft (hysteropexy) is a uterine-sparing alternative. Ten-year outcomes for prolapse surgeries are rarely reported.
Objective
To compare the efficacy and adverse events of these 2 procedures over 10 years.
Design, Setting, and Participants
At 9 clinical sites in the US Pelvic Floor Disorders Network, postmenopausal women with symptomatic uterovaginal prolapse were enrolled in a multisite superiority randomized clinical trial between April 2013 and February 2015. Study data were analyzed from February 2018 to November 2025.
Interventions
Women were originally randomized to vaginal mesh hysteropexy or to vaginal hysterectomy with uterosacral ligament suspension. Participants had 5 years of masked follow-up at 6-month intervals followed by an extended unmasked annual follow-up from 6 to 10 years.
Main Outcomes and Measures
The primary treatment failure composite outcome (retreatment of prolapse, prolapse beyond the hymen, or prolapse symptoms) was evaluated with time-to-failure models. Secondary outcomes included individual anatomic Pelvic Organ Prolapse Quantification measures, bothersome symptoms measured by validated questionnaires, complications and adverse events.
Results
A total of 183 participants (mean [SD] age, 66 [7] years) were randomized, and 175 were included in the intention-to-treat analysis after ineligibility exclusions (88 hysteropexy group and 87 hysterectomy group), 112 of whom (64%; 55 hysteropexy group and 57 hysterectomy group) participated in the 6- to 10-year follow-up extension. There were fewer failures for hysteropexy (35 of 88 [40%]) compared with hysterectomy (46 of 87 [53%]) through 10 years. Time-to-failure analysis showed lower failure risk in hysteropexy (adjusted hazard ratio, 0.64; 95% CI, 0.41-1.00; P = .05). Both groups had sustained improvements in patient reported outcomes with no group differences demonstrated in patient-reported prolapse, urinary, or bowel symptoms, sexual function, dyspareunia, or clinically important complications.
Conclusions and Relevance
Results show that vaginal mesh hysteropexy continued to have a lower composite failure rate through 10 years than vaginal hysterectomy with uterosacral ligament suspension, although an expected increase in durability over the native tissue procedure in years 6 to 10 was not observed. Both procedures are reasonable options for patients. If available, hysteropexy with mesh augmentation for patients who desire uterine preservation is a low risk and effective option.
Trial Registration
ClinicalTrials.gov Identifier: