Uterosacral Versus Sacrospinous Ligament Suspension in Pelvic Organ Prolapse: An RCT

Pelvic organ prolapse is a major cause of morbidity in women, affecting quality of life. The ideal surgical technique for apical support with minimal complications remains debated.

This study aimed to compare the anatomic and surgical success rates between 2 vaginal apical suspension techniques, sacrospinous ligament fixation (SSF) and high uterosacral ligament suspension (HUSLS), in preventing recurrence of pelvic organ prolapse (POP).

A randomized controlled trial was conducted in women undergoing vaginal hysterectomy for POP. Participants were randomly assigned to receive either HUSLS or unilateral SSF. The primary outcomes were anatomic success (Pelvic Organ Prolapse Quantification [POP-Q] stage 0/1) and surgical success (symptom relief without re-surgery) at 1, 6, and 12 months. Secondary outcomes included functional improvement assessed by Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) and Female Sexual Function Index (FSFI) scores.

Of 228 enrolled patients, 204 completed follow-up (HUSLS, 103; SSF, 101). Baseline characteristics and mean POP-Q stage (3.1±0.6 vs 3.2±0.59, P=0.36) were comparable. Operative time was longer in the SSF group (198±18.8 vs 168±21.7 min, P=0.04), but other perioperative outcomes were similar. At 12 months, POP-Q stage 0 was achieved in 75.7% (HUSLS) and 79.2% (SSF), with overall surgical success rates of 84.4% and 85.1%, respectively. POPDI-6 scores improved significantly (72.2±12.8 to 17.3±9.7 in HUSLS; 72.7±14.4 to 19.1±9.2 in SSF, P<0.001). FSFI scores also improved markedly (17.4±4.8 to 25.5±4.6 in HUSLS; 17.5±2.9 to 25.2±3.4 in SSF).

Both HUSLS and SSF are safe and effective for apical prolapse repair, offering comparable anatomic and functional outcomes at 1-year follow-up.