For Vaginal Prolapse, Is One Type of Surgery Any Better Than the Other?

Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known about the comparative efficacy of surgical techniques or the role of perioperative pelvic floor therapy. In the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, 374 women with vaginal prolapse and stress urinary incontinence were randomized first to perioperative behavioral therapy with pelvic floor muscle training (BPMT) or usual care and second to sacrospinous ligament fixation (SSLF) or uterosacral ligament vaginal vault suspension (ULS), with all participants undergoing concomitant retropubic midurethral sling placement. Surgical success was evaluated at 2 years using a composite of objective anat…