This 10-year multicenter RCT (US Pelvic Floor Disorders Network, 9 sites) compared vaginal sacrospinous mesh hysteropexy vs. vaginal hysterectomy with uterosacral ligament suspension in 175 postmenopausal women with symptomatic uterovaginal prolapse, randomized 2013–2015 with 5 years of masked follow-up then annual unmasked follow-up to 10 years.
Hysteropexy had a lower composite failure rate than hysterectomy at 10 years (40% vs. 53%; adjusted HR 0.64, 95% CI 0.41–1.00; P=.05), with no significant differences in patient-reported prolapse, urinary, bowel, sexual function, or dyspareunia symptoms, and no differences in clinically important complications between groups.
- Only 64% of the original cohort (112/175) participated in the 6–10 year extension, raising attrition bias concerns. - Sample size was modest (n=175), limiting power for subgroup analyses. - The anticipated increase in hysteropexy durability over native tissue repair in years 6–10 was not observed, narrowing the long-term advantage.
For postmenopausal women with uterovaginal prolapse who want to keep their uterus, vaginal mesh hysteropexy is a safe, effective option with a modestly lower failure rate over 10 years than hysterectomy plus uterosacral suspension. Both procedures remain reasonable choices, and the decision can be guided by patient preference for uterine preservation.
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