Bottom Line: Uterine prolapse happens when weakened muscles and ligaments no longer provide enough support for the uterus, which then protrudes into or out of the vagina. This randomized clinical trial compared the effectiveness of two surgical methods to treat women: a vaginal hysterectomy to remove the uterus with ligament suspension to support remaining tissue or uterus-sparing suspension techniques, known as hysteropexy. A previous review of trials comparing these techniques didn't find one superior to the other. This study included 175 postmenopausal women with uterine prolapse who had a mesh-augmented repair with the uterus remaining in place (transvaginal mesh hysteropexy) or vaginal hysterectomy (removal of the uterus) with ligament suspension. Researchers report that the vaginal mesh hysteropexy was 12 percentage points better than the hysterectomy procedure at three years for the composite outcome that combined retreatment of prolapse, prolapse beyond the hymen or prolapse symptoms, but this was not quite statistically significant. Further research (including continued follow-up in this trial) is needed to assess whether vaginal mesh hysteropexy is superior. A potential limitation of the study is the inclusion of only postmenopausal women because rates of pain or sexual pain could be different in younger patients.
Authors: Charles W. Nager, M.D., UC San Diego Health, San Diego, and coauthors
(doi:10.1001/jama.2019.12812)
Editor's Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Media advisory: To contact corresponding author Charles W. Nager, M.D., email Michelle Brubaker at mmbrubaker@ucsd.edu. The full study and editorial are linked to this news release.
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JAMA