Nager CW, Visco AG, Richter HE, et al. - Researchers aimed at comparing a sacrospinous hysteropexy with graft (hysteropexy) with a vaginal hysterectomy with uterosacral ligament suspension (hysterectomy), in the management of uterovaginal prolapse, with respect to the efficacy and adverse events. In a multisite randomized superiority clinical trial, they enrolled 183 postmenopausal women requesting vaginal surgery for symptomatic uterovaginal prolapse at 9 clinical sites in the United States National Institutes of Health and National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Among a total of 183 randomized women (mean age of 66 years), 93 were randomized to hysteropexy and 90 were randomized to hysterectomy. Relative to vaginal hysterectomy, sacrospinous hysteropexy with graft resulted in a lower composite failure rate through 5 years. No meaningful disparities were observed in patient-reported outcomes between groups. Based on outcomes, they support making available this vaginal mesh hysteropexy procedure to patients.