Pelvic organ prolapse surgeries have similar outcomes

According to a recent study in JAMA, neither the sacrospinous ligament fixation (SSLF) nor the uterosacral ligament vaginal vault suspension (ULS) procedure is superior to the other in the treatment of vaginal prolapse and stress urinary incontinence.

Researchers at the Cleveland Clinic performed a multicenter, 2 x 2 factorial, randomized trial of 374 patients who underwent surgery to treat both apical vaginal prolapse and stress urinary incontinence between 2008 and 2013 at 9 US medical centers and followed up with them 2 years later. The women were randomized to either the SSLF arm (n = 186) or ULS arm (n = 188) for surgical intervention; they were also randomized into 2 arms for behavioral intervention: perioperative pelvic floor muscle training (BMPT) (n = 186) or usual care (n = 188).

At the 2-year follow-up, the surgical group was not significantly associated with success rates (ULS, 59.2% [93/157] vs SSLF, 60.5% [92/152]; unadjusted difference, −1.3%; 95% confidence interval [CI], −12.2% to 9.6%; adjusted odds ratio [aOR], 0.9; 95% CI, 0.6 to 1.5) or serious adverse event rates (ULS, 16.5% [31/188] vs SSLF, 16.7% [31/186]; unadjusted difference, −0.2%; 95% CI, −7.7% to 7.4%; aOR, 0.9; 95% CI, 0.5 to 1.6). Women in the BMPT group had no greater improvements in urinary scores at 6 months (adjusted treatment difference, −6.7; 95% CI, −19.7 to 6.2), anatomic success at 24 months, or prolapse scores at 24 months (adjusted treatment difference, −8.0; 95% CI, −22.1 to 6.1).

The investigators concluded that neither ULS nor SSLF was superior to the other in terms of anatomic, functional, or adverse event outcomes. Similarly, perioperative BPMT showed no improvement in urinary symptoms at 6 months or prolapse outcomes at 2 years.

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