Pelvic organ prolapse (POP) is a prevalent condition among elderly women, with 24% of East Asian women presenting with advanced POP (stage III or IV). Vaginal vault prolapse recurrence is reported in up to 20% of these patients. Sacrospinous ligament fixation (SSLF) is a well-established transvaginal native-tissue procedure for apical prolapse repair. While permanent sutures offer durability, they carry risks of erosion and bleeding; conversely, absorbable sutures may mitigate these complications. This study aims to compare the risk of recurrence of vaginal vault prolapse following vaginal hysterectomy with SSLF using absorbable versus non-absorbable sutures in women with advanced POP.

This retrospective cohort study analyzed prospectively collected data from a tertiary university hospital. Women with stage III or higher POP who underwent SSLF during vaginal hysterectomy between 2022 and 2024 were included. Baseline demographics, urinary/fecal incontinence, and POP symptoms were recorded during initial consultations. All patients underwent Pelvic Organ Prolapse Quantification (POP-Q) staging. SSLF was performed by a urogynecology subspecialist using a Capio slim device to pass either non-absorbable Prolene (polypropylene) or absorbable PDS (polydioxanone) sutures. Additional procedures, such as colporrhaphy or midurethral slings, were performed as indicated. Patients were followed for at least 12 months postoperatively. At each follow-up visit, we asked about symptoms of prolapse, performed a vaginal examination, and conducted POP-Q assessment. The primary outcome was apical support (point C) at 12 months, with secondary outcomes including symptom of prolapse, recurrence of prolapse defined as stage II or more , apical descent ≥1/2 of total vaginal length (TVL), treatment for recurrence of prolapse, , and local complications including vaginal discharge, vaginal bleeding, granulation tissue.

The study included 90 patients (mean age 64.8 ±9.98 years; mean BMI 24.8 ±3.8 kg/m²), with 39 (43.3%) receiving absorbable PDS and 51 (56.7%) receiving non-absorbable Prolene. Preoperative point C measurements were comparable between groups (PDS: +3.4 ±2.6; Prolene: +4.5 ±1.9).. Regarding the primary outcome, postoperative point C measurements showed no statistically significant difference between groups (PDS: −5.1 ±0.9; Prolene: −4.7 ±1.6; p=0.17).
No statistically significant differences were observed in secondary outcomes. Objective recurrence occurred in 10% (n=4) of the PDS group and 14% (n=7) of the Prolene group, primarily in the anterior compartment. Apical recurrence occurred only in the Prolene group (4%, n=2). 4% (n=2) of the Prolene group reported prolapse symptoms. One patient in each group developed apical granulation tissue. While no reoperations were required, one patient in Prolene group utilized a pessary.

The findings indicate that absorbable PDS sutures provide apical stability comparable to non-absorbable Prolene in SSLF. The absence of a statistically significant difference in postoperative POP-Q point C measurements (p = 0.17) and the similar rates of objective recurrence (10% vs. 14%) at 12 months suggest that permanent suture material is not a mechanical requirement for a durable repair. Notably, apical recurrence occurred only in the permanent suture group, and the incidence of granulation tissue was identical (n=1) in both cohorts. This implies that using absorbable sutures does not compromise anatomical outcomes while potentially mitigating the long-term risks of erosion. However, given the retrospective nature and sample size of this study, a larger cohort and a well-designed randomized controlled trial are necessary to confirm these findings and establish definitive clinical guidelines.

Absorbable PDS sutures are a safe and effective alternative to non-absorbable sutures for SSLF in women with advanced POP over a follow-up period of up to 12 months. They achieve equivalent anatomical support and apical stability without increasing the risk of recurrence or postoperative complications. While current results are promising, future prospective studies will further validate the long-term non-inferiority of absorbable materials in native-tissue apical repairs.

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Continence 19S (2026) 102792
DOI: 10.1016/j.cont.2026.102792