Sutkin G, Zyczynsk HM, Sridhar A, et al. - Researchers examined whether an improved surgical success was achieved with an adjuvant posterior repair at transvaginal apical suspension. They performed a secondary analysis of Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial and assessed 24-month outcomes in 190 participants who had a posterior repair (posterior repair group) vs 184 who did not (no posterior repair group) at the time of sacrospinous ligament fixation or uterosacral ligament suspension. In the posterior repair group, women were less frequently Hispanic or Latina, and had more frequently reported a prior hysterectomy and were more frequently receiving estrogen therapy. Following adjusting for baseline covariates using propensity scores or unadjusted comparison, no correlation of concomitant posterior repair at sacrospinous ligament fixation or uterosacral ligament suspension with surgical success was observed. Posterior repair seems not compensating the pathophysiology that results in enlarged preoperative genital hiatus, which remains prognostic of prolapse recurrence.