Patient-Centered Outcomes in the Surgical Treatment of Uterovaginal Prolapse

Purpose

The purpose of this study is to compare two types of surgery for the treatment of uterovaginal prolapse to determine which surgery works best from a patient's perspective and has the lowest number of short-term and long-term complications.

Condition

  • Uterine Prolapse

Eligibility

Eligible Ages
Between 18 Years and 80 Years
Eligible Genders
Female
Accepts Healthy Volunteers
No

Inclusion Criteria

  1. Women ≥ 18 years of age and ≤ 80 years of age 2. Have diagnosis of symptomatic uterovaginal prolapse 3. Have elected to undergo surgical management of uterovaginal prolapse after consultation with their physician 4. Are eligible for both minimally invasive supracervical hysterectomy with sacrocolpopexy (MI-SCH+SCP) and total vaginal hysterectomy with uterosacral ligament suspension (TVH+USLS)

Exclusion Criteria

  1. Patients who wish to undergo uterine sparing procedures 2. Body mass index BMI) > 50 3. Previous hysterectomy or prior uterovaginal surgery 4. Have a diagnosis of neurogenic bladder, Parkinson's disease, multiple sclerosis, spinal cord injury, or cerebrovascular accident 5. Chronic indwelling urinary catheter 6. Urinary diversion of any type 7. Any condition or disorder that, in the opinion of the investigator, might prevent the subject from completing the study or interfere with the interpretation of the study results 8. Unable to speak, read, understand English

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Intervention Model Description
The study is utilizing a 1:1 randomization scheme (by site) to assign patients to one of two treatment arms: 1) minimally invasive supracervical hysterectomy with sacrocolpopexy (MI-SCH+SCP, N=160) or 2) total vaginal hysterectomy with uterosacral ligament suspension (TVH+USLS, N=160).
Primary Purpose
Treatment
Masking
Single (Participant)
Masking Description
Participants will be masked to the surgical randomization prior to surgery and will be informed of their surgical assignment (unmasked) after waking up from surgery and prior to discharge.

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Sacrocolpopexy
Minimally invasive supracervical hysterectomy with sacrocolpopexy (MI-SCH+SCP)
  • Procedure: Minimally invasive supracervical hysterectomy and sacrocolpopexy (MI-SCH+SCP)
    Minimally invasive robotic or laparoscopic supracervical hysterectomy will be done, and the vaginal apex (including cervix) will be suspended utilizing sacrocolpopexy mesh to the anterior spinous ligament.
Active Comparator
Uterosacral Ligament Suspension
Total vaginal hysterectomy with uterosacral ligament suspension (TVH+USLS)
  • Procedure: Vaginal hysterectomy with uterosacral ligament suspension (TVH+USLS)
    The uterus will be removed vaginally and the vaginal apex will be suspended utilizing sutures in the uterosacral ligament.

Recruiting Locations

MetroHealth Medical Center
Cleveland, Ohio 44109
Contact:
Stephanie Kanuch
216-280-2915
skanuch@metrohealth.org

More Details

Status
Recruiting
Sponsor
University Hospitals Cleveland Medical Center

Study Contact

Grace Pelfrey
216-286-8005
Grace.Pelfrey@uhhospitals.org

Detailed Description

This is a multi-site, randomized controlled trial, where women with the confirmed diagnosis of uterovaginal prolapse will be randomized in a 1:1 ratio to either A) a minimally invasive supracervical hysterectomy with sacrocolpopexy (MI-SCH+SCP) or B) total vaginal hysterectomy with uterosacral ligament suspension (TVH+USLS). After surgery, participants will be followed for 3 years including physical pelvic exams and validated symptom questionnaires to assess for the primary and secondary outcomes. A subset of participants will participate in semi-structured interviews, before surgery and through 2 years after surgery, that will assess patient recovery, satisfaction with care, and calibrate surveyed and clinically assessed outcomes to the daily life experiences of women.