***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction and hypothesisIn a retrospective study , the sacrospinous hysteropexy was associated with a shorter recovery time compared to a vaginal hysterectomy with no differences in anatomical outcomes . No r and omized trials are performed . Methods Sixty-six women with stage 2–4 uterine descent were r and omized for vaginal hysterectomy(31 ) or sacrospinous hysteropexy(35 ) . Recovery time , anatomical outcomes , functional outcomes , and quality of life were measured . Results Length of time to return to work was shorter after a sacrospinous hysteropexy ( 43 versus 66 days , p = 0.02 ) . The difference in risk for recurrent prolapse stage 2 or more of the apical compartment at 1-year follow-up was 17 % ( 95 % confidence interval , 2 to 30 ) in favor of the vaginal hysterectomy . No differences in quality of life and urogenital symptoms were found . Conclusions The sacrospinous hysteropexy for uterine descent is associated with an earlier recovery time , more recurrent apical prolapses but no differences in functional outcomes , and quality of life OBJECTIVES This prospect i ve , r and omised study investigated whether a prophylactic procedure , performed during colposacropexy for prolapse repair , prevents ex novo postoperative incontinence .  Sixty-six consecutive continent patients with advanced prolapse were r and omised into two groups : group A underwent sacropexy combined with a Burch colposuspension ; no anti-incontinence procedure was performed in group B patients . METHODS Work-up included clinical assessment ( Halfway System and International Continence Society [ ICS ] classification for prolapse and Ingelman Sunderberg scale for incontinence ) , the Urogenital Distress Inventory and Impact Incontinence Quality of Life question naires , urogynaecologic ultrasound scans , and complete urodynamic testing that included the urethral pressure profile and Valsalva leak point pressure with reduced prolapse . Check-ups were done at 3 , 6 , 12 mo postoperatively and then yearly . Mean follow-up time was 39.5 mo . RESULTS The mean age ( + /- st and ard deviation ) was 62+/-9 yr . All patients presented with  grade ( G ) 3 - 4 prolapse . Postoperative incontinence was present in 12 of the 34 patients in group A : 7 G1 ; 4 G2 , and 1 G3 . Postoperative incontinence was present in 3 of the 32 patients in group B : 2 G1 , 1 G3 . The frequency of postoperative incontinence was significantly greater in patients who had undergone colposuspension ( p<0.05 ) . CONCLUSIONS These preliminary data cast doubt on whether colposuspension should be performed during sacropexy for severe urogenital prolapse as prophylaxis for postoperative incontinence because it seems to emerge as overtreatment . Incontinence developed ex novo in 35 % of continent patients treated with colposuspension combined with sacropexy OBJECTIVE : To present the 3-year outcomes of a double-blind , multicenter , r and omized trial comparing vaginal prolapse repair with and without mesh . METHODS : This was a planned final analysis of women with Pelvic Organ Prolapse Quantification ( POP-Q ) stage 2–4 prolapse r and omized to traditional vaginal prolapse surgery without mesh and vaginal colpopexy repair with mesh .  We evaluated anatomic , symptomatic , and combined cure rates for those with at least 3-year vali date d quality -of-life question naires and 2- or 3-year postoperative blinded POP-Q examination . Participants undergoing reoperation for recurrent prolapse were removed for anatomic and subjective outcomes analysis and considered failures for combined outcomes analysis . RESULTS : Sixty-five women were enrolled ( 33 mesh , 32 no mesh ) before the study was prematurely halted as a result of a 15.6 % mesh exposure rate . At 3 years , 51 of 65 ( 78 % ) had quality -of-life question naires ( 25 mesh , 26 no mesh ) and 41 ( 63 % ) had examinations . Three participants died , three required reoperation for recurrent prolapse ( all in mesh group ) , and eight were lost to follow-up . No differences were observed between groups at 3 years for prolapse stage or individual prolapse points . Stage improved for each group ( 90 % and 86 % ) from baseline to 3 years ( P<.01 ) . Symptomatic improvement was observed with no differences in scores between groups . Cure rates did not differ between groups using a variety of definitions , and anatomic cure was lowest for the anterior compartment . CONCLUSION : There was no difference in 3-year cure rates when comparing patients undergoing traditional vaginal prolapse surgery without mesh  with those undergoing vaginal colpopexy repair with mesh .  CLINICAL TRIAL REGISTRATION : Clinical trials.gov , www . clinical trials.gov , NCT00475540 . LEVEL OF EVIDENCE : OBJECTIVE To compare the laparoscopic sacral colpopexy and total vaginal mesh for vaginal vault prolapse . STUDY DESIGN Women with symptomatic stage ≥2 vault prolapse were r and omly allocated the laparoscopic sacral colpopexy ( 53 ) or total vaginal mesh ( 55 ) . Primary outcome measures were objective success rates at pelvic organ prolapse quantification sites individually and collectively . Secondary outcome measures included perioperative outcomes , patient satisfaction , quality of life outcomes , complications , and reoperations . RESULTS The laparoscopic sacral colpopexy group had a longer operating time , reduced inpatient days , and quicker return to activities of daily living as compared with the total vaginal mesh group . At the 2-year review , the total objective success rate at all vaginal sites was 41 of 53 ( 77 % ) for laparoscopic sacral colpopexy as compared with 23 of 55 ( 43 % ) in total vaginal mesh ( P < .001 ) . Reoperation rate was significantly higher after the vaginal mesh surgery 12 of 55 ( 22 % ) as compared with laparoscopic sacral colpopexy 3 of 53 ( 5 % ) ( P = .006 ) . CONCLUSION At 2 years , the laparoscopic sacral colpopexy had a higher satisfaction rate and objective success rate than the total vaginal mesh with lower perioperative morbidity and reoperation rate Introduction and hypothesisThe high uterosacral vault suspension ( HUVS ) is a vaginal approach for treating apical prolapse that provides shorter operative and recovery times and is associated with lower morbidity rates . Success rates reported for this technique are comparable with the abdominal sacrocolpopexy ( SCP ) ; however , to date , there are no prospect i ve r and omized studies comparing HUVS to SCP . The aim of the study was to compare the anatomical objective cure rates for the apical compartment in patients undergoing either HUVS or SCP at 12 months ’ follow-up . Methods We performed a single-center parallel r and omized controlled trial in patients with severe apical defect defined as Pelvic Organ Prolapse Quantification ( POP-Q ) point C ≥ stage 3 . Based on the center ’s previous experience , a sample size of 124 patients was required to show a 20 % cure rate difference between both techniques with 80 % power and using a two-tailed 5 % level of significance . One hundred and ten patients were available for analysis ; 54 were allocated to abdominal SCP and 56 to HUVS . The primary outcome was to evaluate surgical objective success defined as POP-Q point C stage<2 . The Pelvic Floor Distress Inventory ( PFDI-20 ) , the Perceived Quality of Life Scale ( P-QOL ) , and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Question naire ( PISQ-12 ) question naires were used for subjective assessment . Results The objective success rate for apical suspension at 12 months ’ follow-up was 100 % for abdominal SCP and 82.5 % for HUVS ( log-rank p 0.033 ) . Both techniques showed a significant improvement with regards to prolapse symptoms , quality of life ( QOL ) , and sexual function . The significant improvement in postoperative question naires was comparable between both surgeries at 12 months ’ follow-up . Conclusions Abdominal SCP has statistically significant better anatomical results when compared with HUVS for correcting apical defects at 12 months Objective To investigate whether uterus preserving vaginal sacrospinous hysteropexy is non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments in the surgical treatment of uterine prolapse . Design Multicentre r and omised controlled non-blinded non-inferiority trial . Setting 4 non-university teaching hospitals , the Netherl and s. Participants 208 healthy women with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery . Interventions Treatment with sacrospinous hysteropexy or vaginal hysterectomy with suspension of the uterosacral ligaments . The predefined non-inferiority margin was an increase in surgical failure rate of 7 % . Main outcome measures Primary outcome was recurrent prolapse stage 2 or higher of the uterus or vaginal vault ( apical compartment ) evaluated by the pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse at 12 months ’ follow-up . Secondary outcomes were overall anatomical recurrences , including recurrent anterior compartment ( bladder ) and /or posterior compartment ( bowel ) prolapse , functional outcome , complications , hospital stay , postoperative recovery , and sexual functioning .  Results Sacrospinous hysteropexy  was non-inferior for anatomical recurrence of the apical compartment with bothersome bulge symptoms or repeat surgery ( n=0 , 0 % ) compared with vaginal hysterectomy with suspension of the uterosacral ligaments ( n=4 , 4.0 % , difference −3.9 % , 95 % confidence interval for difference −8.6 % to 0.7 % ) . At 12 months , overall anatomical recurrences , functional outcome , quality of life , complications , hospital stay , measures on postoperative recovery , and sexual functioning did not differ between the two groups . Five serious adverse events were reported during hospital stay . None was considered to be related to the type of surgery . Conclusions Uterus preservation by sacrospinous hysteropexy was non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments for surgical failure of the apical compartment at 12 months ’ follow-up . Trial registration trialregister.nl NTR1866 Introduction and hypothesisThis trial aim ed to compare the outcomes of native vaginal tissue repair versus polypropylene mesh repair for the treatment of severe genital prolapse . Methods This multicenter r and omized trial included 184 women , with POP-Q stage 3 or 4 . They were r and omly assigned to undergo surgical treatment using native tissue repair ( n = 90 ) or synthetic mesh repair ( n = 94 ) . Native tissue repair surgery was performed according to site-specific defects , including sacrospinous ligament fixation for apical defects . Mesh repair ( Prolift ™ ) was performed in accordance with manufacturer recommendations . Hysterectomy was performed in all cases of uterine prolapse . Statistical tests were used to compare between-group and within-group differences before the surgery and at 1-year follow-up . We considered cure to have occurred when the POP-Q point evaluation was equal to or less than 0 and POP-Q point C better than or equal to half the total vaginal length ( TVL ) after 1 year . The patients answered the Prolapse Quality -of-Life Question naire ( PQoL ) and the Sexual Quotient Female Version ( QS-F ) question naire . Results Both groups were homogeneous preoperatively . There were no differences between the groups in operative time , complications or pain . At 1-year follow-up , anatomical cure rates were better in the mesh group in the anterior compartment ( p = 0.019 ) . Significant improvement in PQoL scores at 1-year follow up were observed in each group ; between-group comparisons of changes in PQoL scores revealed greater improvement in the mesh group . Conclusion Both techniques were effective . Anatomical efficacy was superior in the mesh group regarding the anterior compartment ; quality of life changes were also greater in the mesh  group . Complications were significantly higher in the mesh group AIMS With respect to urogenital function , vaginal hysterectomy combined with anterior and /or posterior colporraphy has been shown to be superior to abdominal sacrocolpopexy with preservation of the uterus . We performed a r and omized trial to compare the effects of both procedures on pain , quality of life and physical performance during the first six weeks after surgery . METHODS Eighty-two patients were r and omized to have surgery either by vaginal or abdominal approach . All patients were asked to complete the R AND -36 before surgery and 6 weeks after surgery and to keep a diary for the first 6 weeks after surgery . This diary assessed the pain perception and use of pain medication , bother of limitations due to the surgery and performance of daily activities after surgery . These outcomes were compared . RESULTS All patients completed the R AND -36 and 68 patients completed the diary . Patients who had undergone abdominal surgery had a statistically lower score on the health change domain ( 56 vs 68 ) , bodily pain domain ( 63 vs 80 ) and mental health domain ( 7 
    Output:
    
Sacral colpopexy is associated with lower risk of awareness of prolapse , recurrent prolapse on examination , repeat surgery for prolapse , postoperative SUI and dyspareunia than a variety of vaginal interventions .The limited evidence does not support use of transvaginal mesh compared to native tissue repair for apical vaginal prolapse .
Most of the evaluated transvaginal meshes are no longer available and new lighter meshes currently lack evidence of safetyThe evidence was inconclusive when comparing access routes for sacral colpopexy .
No clear conclusion can be reached from the available data comparing uterine preserving surgery versus vaginal hysterectomy for uterine prolapse