A randomized controlled trial of permanent vs absorbable suture for uterosacral ligament suspension
Open accessAbstract
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. 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. 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. Absorbable suture for USLS is not inferior to permanent suture for apical anatomic outcomes.
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A single study reported no difference between absorbable and non-absorbable sutures for anterior compartment prolapse (RR 0.20, 95% CI 0.01 to 3.92; 1 RCT, n = 40).
“A single study (Kowalski 2021) reported no difference between the two groups (RR 0.20, 95% CI 0.01 to 3.92; 1 RCT, n= 40, Analysis 7.3).”
From Surgery for women with apical vaginal prolapse (2023) · cites this paper as Kowalski 2021
The Results (page unavailable) report that 40 participants completed follow-up and that no differences were seen between suture groups in any outcome measure. However, our copy does not report a separate anterior-compartment prolapse result or the quoted RR and confidence interval; those specifics are not supported by this source. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere is no evidence of a difference between absorbable and non-absorbable sutures for repeat surgery for recurrent prolapse; two studies reported no cases of surgery for prolapse recurrence in either group.
“There was no evidence of difference between the two groups with two studies (Kowalski 2021; Matthews 2020) reporting no cases of surgery for prolapse recurrence in either group (Analysis 7.2).”
From Surgery for women with apical vaginal prolapse (2023) · cites this paper as Kowalski 2021
A single study reported no posterior compartment prolapse in either absorbable or non-absorbable suture group.
“A single study (Kowalski 2021) reported no posterior compartment prolapse in either group (Analysis 7.3).”
From Surgery for women with apical vaginal prolapse (2023) · cites this paper as Kowalski 2021
The Results report outcomes for both suture groups, including composite failure and no prolapse retreatment, but do not report posterior-compartment prolapse separately. Searches for “posterior compartment” and posterior POP-Q outcomes found no passage establishing zero posterior prolapse in either group; no retreatment is not the same outcome. No page number is available in our copy. (LLM, conf=0.72)
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Surgery for women with apical vaginal prolapse
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- Authors
- Kowalski, J. T., Genadry, R., Ten Eyck, P., & Bradley, C. S.
- Affiliations
- University of Iowa Hospitals and Clinics (US)
- Corresponding author
- Kowalski, Joseph T.
- Venue
- International Urogynecology Journal
- Published
- 2020-02-11
- Volume
- 32
- Issue
- 4
- Pages
- 785-790
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- PMC
- PMC7771887
- OpenAlex
- W2996862074
- Semantic Scholar
- f54745ada811cac3125c0ac9ef506c4b8bb01315
- Cited by
- 20
- References
- 12
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 1 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 3
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Urogynecology Journal (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- International Urogynecological Association (IUGA 2016 Clinical Research Grant)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Ureteral procedures and complications
- Keywords
- uterosacral ligament suspension, absorbable sutures, non-absorbable sutures, apical pelvic organ prolapse, surgical outcomes, non-inferiority
- MeSH terms
- Fascia, Female, Humans, Ligaments, Middle Aged, Gynecologic Surgical Procedures, Sutures, Uterus, Treatment Outcome, Pelvic Organ Prolapse
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