Table 1.

Inclusion and Exclusion Criteria^*

Inclusion criteria:

Vaginal bulge symptoms as indicated by an affirmative response to either question 4 or 5 of the PFDI: ○ Do you usually have a sensation of bulging or protrusion from the vaginal area? ○ Do you usually have a bulge or something falling out that you can see or feel in the vaginal area? Anterior vaginal prolapse defined by POP-Q Point Aa ≥ −1 cm (i.e., −1,0,1,2, or 3 cm) Surgical plan that includes a vaginal approach for apical or anterior prolapse repair Able and willing to complete data collection per protocol, including written informed consent

Exclusion criteria:

Pregnancy or planning pregnancy in the first postoperative year Any prior mid urethral sling Currently participating in another interventional study for urinary incontinence Untreated urinary tract infection (may be included after resolution) Symptoms of stress urinary incontinence as defined by a positive response to any of the following 3 PFDI items: ○ Do you usually experience urine leakage related to coughing, sneezing, or laughing? ○ Do you usually experience urine leakage related to physical exercise such as walking, running, aerobics, or tennis? ○ Do you usually experience urine leakage related to lifting or bending over? Currently being treated for stress urinary incontinence with pessary/incontinence ring, pelvic floor muscle exercise or medication (duloxetine and imipramine, and alpha agonists). Current use of vaginal or systemic (oral, skin patch) estrogen is not an exclusion criterion.

PFDI= Pelvic Floor Distress Inventory, POPQ=Pelvic Organ Prolapse Quantification

^*Urodynamic studies are not required as a part of this trial.