Table 3.

Standardized Procedures for the Two Surgeries in the SUPeR study

TVH/ULS ULS is performed through the vaginal incision after the vaginal hysterectomy. The placement of uterosacral ligament stitches is performed in such a way as to avoid neurovascular and ureteral compromise. One permanent and one delayed absorbable 0 or 2-0 monofilament suture (2 sutures per side; 4 sutures total) are placed in each ligament, extending to the ipsilateral anterior and posterior fibromuscular wall of the vaginal apex. The permanent sutures are placed near full thickness, excluding vaginal epithelium. The delayed absorbable sutures are placed full thickness through the vaginal walls. The type of suture material is recorded. No plication of the uterosacral ligaments across the midline or culdoplasty is allowed.

Uphold® LITE Procedure Hydrodissection of the vaginal walls is performed with at least 30 cc of 0.25% bupivicaine with epinephrine or dilute vasopressin (20 Units/50–100 cc) A 4 cm transverse vaginal incision is made in the anterior vaginal wall between the bladder neck and the cervix but at least 3 cm from the cervix so that the suture line will not overlap with the mesh. Blunt or sharp dissection is allowed to approach the sacrospinous ligament extraperitoneally. After confirmation of the location of the ischial spine, the tapered lead and mesh assembly is delivered into the sacrospinous ligament 1–2 fingerbreadths medial to the ischial spine. The most cephalic edge of the mesh is attached to the cervix with sutures. Mesh modifications (e.g. cutting) are strongly discouraged; any exceptions will be documented on operative case report forms. Tensioning is performed to re-suspend the apex without tense mesh arms. Vaginal closure is performed with 2-0 polyglactin suture. A vaginal pack and indwelling urethral catheter are placed and removed on postoperative day 1.