Mesh SCP Is Superior to SSLF for Vaginal Vault Prolapse

Background: After hysterectomy, vaginal vault prolapse is common. However, 3 widely used repairs for post-hysterectomy vaginal vault prolapse have never been compared in a randomized clinical trial (RCT). Objective: To compare the efficacy and safety of 3 different surgical approaches for vaginal vault prolapse post-hysterectomy. Design/Participants: Multisite, 3-arm, superiority, noninferiority RCT including women with symptomatic vaginal vault prolapse after hysterectomy who needed surgical correction. Methods: The authors undertook this RCT to determine which approach is superior, with outcomes assessed over 5 years, funded by the National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Patients were randomized to mesh-augmented sacrocolpopexy (SCP), mesh vaginal suspension (Uphold™ mesh), or transvaginal native tissue repair (NTR; sacrospinous ligament fixation [SSLF]). The primary outcome was time until failure, defined as retreatment, prolapse pa more...