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Vault or Uterine prolapse surgery Evaluation – two parallel randomised controlled trials of surgical options for upper compartment (uterine or vault) pelvic organ prolapse


The primary objective is to determine the optimal surgical management for women with upper compartment (uterine or vault) pelvic organ prolapse, in terms of clinical effectiveness, cost-effectiveness and adverse events. The two parallel trials will compare: (a) in women having uterine prolapse surgery, the effects of removal of the uterus versus uterine preservation; {b) in women having vault prolapse surgery, the effects of a vaginal vault suspension versus an abdominal vault suspension.


Gynaecologists have recognised for some time that both anatomical failure and recurrence of prolapse symptoms after surgery are common: one in three women who have a prolapse operation will go on to have another, though not necessarily in the same compartment. More recently, it has also been recognised that surgery can be followed by a greater impairment of quality of life than from the original prolapse itself (for example the development of new-onset urinary incontinence after surgery, or prolapse at a different site). Whilst anterior and posterior prolapse surgery is most common (90% of operations), around 43% of women also have a uterine (34%) or vault (9%) procedure at the same time. Indeed, this demonstrates that women who have a hysterectomy have around a 27% chance of needing a subsequent vault prolapse repair. These data are derived from the first 700 women recruited in PROSPECT, a large HTA-funded UK RCT of anterior or posterior prolapse surgery with or without the use of mesh {HTA No. 07/60/18). In VUE, the opportunity has arisen to then switch from randomising between lower compartment surgery to trials involving different surgical options for upper compartment prolapse (uterine and vault).

Principal Investigator: University of Aberdeen

NMAHP Research Unit Collaborators: Professor Suzanne Hagen, Andrew Elders

External Collaborators: Bain, C - NHS Grampian, Breeman, S - University of Aberdeen, Cooper, K - NHS Grampian, Freeman, R - Plymouth Hospital NHS Trust, Kilonzon, M - University of Aberdeen, McDonald, A - University of Aberdeen, McPherson, G - University of Aberdeen, Norrie, J - University of Aberdeen, Smith, A - Central Manchester University Hospitals NHS Foundation Trust.

Funder: NIHR

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