{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:34:33Z","timestamp":1793370873755,"version":"4.5.0"},"reference-count":63,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,8,15]]},"abstract":"\n Importance<\/jats:title>\n In many countries, sacrospinous hysteropexy is the most commonly practiced uterus-preserving technique in women undergoing a first operation for pelvic organ prolapse. However, there are no direct comparisons of outcomes after sacrospinous hysteropexy vs an older technique, the Manchester procedure.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare success of sacrospinous hysteropexy vs the Manchester procedure for the surgical treatment of uterine descent.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Multicenter, noninferiority randomized clinical trial conducted in 26 hospitals in the Netherlands among 434 adult patients undergoing a first surgical treatment for uterine descent that did not protrude beyond the hymen.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomly assigned to undergo sacrospinous hysteropexy (n\u2009=\u2009217) or Manchester procedure (n\u2009=\u2009217).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was a composite outcome of success, defined as absence of pelvic organ prolapse beyond the hymen in any compartment evaluated by a standardized vaginal support quantification system, absence of bothersome bulge symptoms, and absence of prolapse retreatment (pessary or surgery) within 2 years after the operation. The predefined noninferiority margin was 9%. Secondary outcomes were anatomical and patient-reported outcomes, perioperative parameters, and surgery-related complications.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 393 participants included in the as-randomized analysis (mean age, 61.7 years [SD, 9.1 years]), 151 of 196 (77.0%) in the sacrospinous hysteropexy group and 172 of 197 (87.3%) in the Manchester procedure group achieved the composite outcome of success. Sacrospinous hysteropexy did not meet the noninferiority criterion of \u22129% for the lower limit of the CI (risk difference, \u221210.3%; 95% CI, \u221217.8% to \u22122.8%;\n P<\/jats:italic>\n \u2009=\u2009.63 for noninferiority). At 2-year follow-up, perioperative outcomes and patient-reported outcomes did not differ between the 2 groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Based on the composite outcome of surgical success 2 years after primary uterus-sparing pelvic organ prolapse surgery for uterine descent, these results support a finding that sacrospinous hysteropexy is inferior to the Manchester procedure.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n TrialRegister.nl Identifier:\n NTR 6978<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.13140","type":"journal-article","created":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T11:36:15Z","timestamp":1692099375000},"page":"626","source":"Crossref","is-referenced-by-count":43,"title":["Manchester Procedure vs Sacrospinous Hysteropexy for Treatment of Uterine Descent"],"prefix":"10.1001","volume":"330","author":[{"given":"Rosa A.","family":"Enklaar","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sascha F. 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