Anterior repair versus no anterior repair for anterior vaginal wall prolapse resolved under simulated apical support at the time of uterosacral ligament suspension

Introduction and hypothesis The aim of this study was to compare treatment outcomes 1 year after uterosacral ligament suspension (USLS) with or without concomitant anterior repair (AR) for anterior vaginal wall prolapse resolved under simulated apical support. Methods This retrospective cohort study included 179 women who underwent USLS with or without concomitant AR for Pelvic Organ Prolapse Quantification (POPQ) stage 2-4 anterior vaginal wall prolapse resolved under simulated apical support, and who completed a 1-year follow-up. The primary outcome was composite surgical failure defined as anterior anatomical recurrence (point Ba>0), symptomatic recurrence (presence of vaginal bulge symptoms), or retreatment for prolapse. Secondary outcomes included changes in POPQ values and Urogenital Distress Inventory-6 (UDI-6) scores, perioperative outcomes, and complications. Results Eighty-six women underwent concomitant AR, and 93 did not. The group receiving AR had more advanced anterior and apical prolapse. Surgical failure rates were significantly higher in the group not receiving AR than in the group receiving AR (21.5% vs 7.0%, p < 0.01). However, there were no differences in the mean point Ba and C values and UDI-6 scores through 12 months postoperatively between the two groups. Operating times were longer, and adverse events, such as immediate postoperative urinary retention and minor wound complications, were more frequent in the group receiving AR (p < 0.05). Conclusions Concomitant AR at the time of USLS seems to reduce the recurrence of anterior vaginal wall prolapse without significant morbidity. Considering the small difference in anatomical outcomes, a longer follow-up period will be required to confirm this.