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Randomized Controlled Trial
. 2021 Apr;32(4):785-790.
doi: 10.1007/s00192-020-04244-1. Epub 2020 Feb 11.

A randomized controlled trial of permanent vs absorbable suture for uterosacral ligament suspension

Joseph T Kowalski  1 , Rene Genadry  2 , Patrick Ten Eyck  3 , Catherine S Bradley  2
Affiliations
Randomized Controlled Trial

A randomized controlled trial of permanent vs absorbable suture for uterosacral ligament suspension

Joseph T Kowalski et al. Int Urogynecol J. 2021 Apr.

Abstract

Introduction and hypothesis: Uterosacral ligament suspension (USLS) is a common procedure for apical pelvic organ prolapse. The procedure has been described using only permanent suture, only absorbable suture and a combination of permanent and absorbable suture. We hypothesized that the use of absorbable suture is not inferior to the use of permanent suture.

Methods: All women undergoing USLS between October 2016 and November 2017 were approached. Subjects were randomized to permanent or absorbable suture. The primary outcome was POP-Q point C 12 months after surgery (non-inferiority limit = 2 cm). A composite outcome of success at 12 months was defined as no apical prolapse ≥ 1/2 TVL, no prolapse beyond the hymen, no prolapse retreatment and no bulge symptoms.

Results: Forty-four subjects with mean (SD) age 62.9 (12.0) years and body mass index 29.1 (5.4) kg/m2 were enrolled and underwent USLS. Fifteen (34.1%) had POP-Q stage II and 29 (65.9%) stage III prolapse. Twenty-two were randomized to permanent and 22 to absorbable suture. Forty (90.9%) completed the 12-month follow-up. Median (IQR) POP-Q point C at 12 months was -7 (-10, -6) for the permanent and - 7 (-9, -5.5) for the absorbable suture groups (p = 0.65, non-inferiority p < 0.0002). Four (20%) in the permanent and one (5%) in the absorbable suture group reported bulge symptoms (p = 0.34). Fifteen (75%) in the permanent and 18 (90%) in the absorbable suture groups met criteria for composite success (p = 0.41). Intervention-related adverse outcomes were uncommon and not different between groups.

Conclusion: Absorbable suture for USLS is not inferior to permanent suture for apical anatomic outcomes.

Keywords: Prolapse; Surgery; Trial.

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Conflict of interest statement

Conflicts of Interest:

The authors declare that they have no conflict of interest

Figures

Figure 1.
Figure 1.
CONSORT flow diagram.
See this image and copyright information in PMC

References

    1. Wu JM, et al., Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol, 2014. 123(6): p. 1201–6. - PMC - PubMed
    1. Barber MD, et al., Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA, 2014. 311(10): p. 1023–34. - PMC - PubMed
    1. Shull BL, et al., A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol, 2000. 183(6): p. 1365–73; discussion 1373–4. - PubMed
    1. Kasturi S, et al., High uterosacral ligament vaginal vault suspension: comparison of absorbable vs. permanent suture for apical fixation. Int Urogynecol J, 2012. 23(7): p. 941–5. - PubMed
    1. Chung CP, et al., Permanent suture used in uterosacral ligament suspension offers better anatomical support than delayed absorbable suture. Int Urogynecol J, 2012. 23(2): p. 223–7. - PubMed

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