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Visceral ProlapseASPIReNCT02676973

Apical Suspension Repair for Vault Prolapse In a Three-Arm Randomized Trial Design

A study testing Open, Robotic, or Laparoscopic, Transvaginal Native Tissue Repair and Uphold™ LITE in people with Visceral Prolapse, run by NICHD Pelvic Floor Disorders Network at 10 sites in United States.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The study is a multi-center, randomized, surgical trial of women with symptomatic post-hysterectomy apical (cuff) prolapse desiring surgical treatment. This study will compare the three available surgical treatments performed in usual practice. Read more about this study

Who is it for?
Ages 21 years and older, women only
Conditions the study is for
Visceral Prolapse
What is being tested?
Open, Robotic, or Laparoscopic, Transvaginal Native Tissue Repair and Uphold™ LITE
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
360 participants
Where
10 sitesUnited States
Study dates
29 Feb 2016to 31 Dec 2026
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Women age 21 or older
  • Prior total hysterectomy (no cervix present)
  • Prolapse beyond the hymen (defined as Ba, C, or Bp > 0 cm)
  • Vaginal cuff descent into at least the lower two thirds of the vagina (defined as point C> -2/3 TVL)
  • Bothersome bulge symptoms as indicated on question 3 of the PFDI-20 form relating to 'sensation of bulging' or 'something falling out'
  • Desires surgical treatment for post-hysterectomy vaginal prolapse
  • Available for up to 60 month follow-up

Who cannot join

  • Previous synthetic material or biologic grafts (placed vaginally or abdominally) to augment POP repair including anterior, posterior and/or apical compartments
  • Known previous formal SSLS performed for either uterovaginal or post-hysterectomy vaginal vault prolapse *
  • Known adverse reaction to synthetic mesh or biological grafts; these complications include but are not limited to erosion, fistula, or abscess
  • Unresolved chronic pelvic pain-active
  • Prior abdominal or pelvic radiation
  • Contraindication to any of the index surgical procedures
Show all 13Show fewer
  • Known Horseshoe Kidney or Pelvic Mass overlying the sacrum
  • Active diverticular abscess or active diverticulitis
  • Shortened vaginal length (<6 cm TVL)
  • NOTE:
  • Only documented SSLS will be an exclusion.
  • Mesh used for only mid-urethral sling will NOT be an exclusion
  • If prior POP repair is unknown and unable to be documented, subjects will be eligible based on clinician judgment. The investigator will examine and assess for evidence of mesh or graft if no evidence of mesh or graft is present on examination subject remains eligible.

Trial locations and contacts

10 sites in 1 country.

10 sites in 1 country

United States10 sites
  • University of New Mexico

    Albuquerque, New Mexico, 87131

  • University of Alabama at Birmingham

    Birmingham, Alabama, 35233

  • Cleveland Clinic

    Cleveland, Ohio, 44195

  • University of Texas Southwestern Medical Center

    Dallas, Texas, 75390

  • Duke University

    Durham, North Carolina, 27707

  • University of Pennsylvania

    Philadelphia, Pennsylvania, 19118

  • University of Pittsburgh

    Pittsburgh, Pennsylvania, 15213

  • Brown/Women and Infants Hospital of Rhode Island

    Providence, Rhode Island, 02903

  • University of California at San Diego

    San Diego, California, 92037

  • Kaiser Permanente

    San Diego, California, 92110

Other trials in United States

About this study

Official title: Three Arm Apical Suspension Trial for Post-Hysterectomy Vault Prolapse: Prospective Randomized Trial Involving Sacral Colpopexy, Transvaginal Mesh and Native Tissue Apical Repair

The study is a multi-center, randomized, surgical trial of women with symptomatic post-hysterectomy apical (cuff) prolapse desiring surgical treatment. This study will compare the three available surgical treatments performed in usual practice. The purpose of this study is to compare two commonly performed mesh apical repair (sacral colpopexy vs. Apical Transvaginal Mesh) and vaginal native tissue apical repairs with mesh reinforced repairs. The primary outcome is measured over time (up to 60 months) using a survival analysis approach. Participants will be followed for at least 36-months (3-years) post surgery and up to a maximum of 60-months (5-years) during the primary trial. Participants who complete the primary trial will be approached for consent for long-term follow-up as part of a study extension and will be followed up to a maximum of 120-months (10-years).

The investigators hypothesize that treatment failure will not differ between vaginally and abdominally placed mesh for vault vaginal prolapse, and mesh repairs (regardless of route of implantation) will be superior to native tissue apical suspension.

Read the detailed description

The primary purpose of this three arm randomized clinical trial is to determine if apical transvaginal mesh placement is non-inferior to sacral colpopexy for anatomic correction of post-hysterectomy vaginal vault prolapse and to determine if mesh reinforced repairs performed by abdominal or vaginal approach are superior to native tissue vaginal repair. This trial has the following primary aims:

  1. To determine if Apical Transvaginal Mesh is non-inferior to Sacral Colpopexy for anatomic correction of post-hysterectomy vaginal vault prolapse at time points through 3 years.

1A. In the case where Apical Transvaginal Mesh is shown to be statistically significantly non-inferior to Sacral Colpopexy for anatomic correction of post-hysterectomy vaginal vault prolapse at time points through 3 years, to determine if Apical Transvaginal Mesh is superior to Sacral Colpopexy for anatomic correction of post-hysterectomy vaginal vault prolapse at time points through 3 years.

  1. To determine if Sacral Colpopexy is superior to Native Tissue Repair for anatomic correction of post-hysterectomy vaginal vault prolapse at time points through 3 years.
  2. To determine if Apical Transvaginal Mesh is superior to Native Tissue Repair for anatomic correction of post-hysterectomy vaginal vault prolapse at time points through 3 years.

Additional secondary aims include:

  1. Evaluate the development of a valid and reliable Global Composite Outcome that balances adverse events and patient-centered outcomes to anatomic definitions of failure and success.
  2. Determine the impact of preoperative frailty and mobility on surgical treatment outcomes and postoperative complications of older women following surgical correction of apical pelvic organ prolapse.
  3. Evaluate the patient's perspective about adverse events and their role in patient decision-making outcomes. The aims include comparing patient versus surgeon rankings of complication grade, outcome, expectedness and seriousness, to estimate the association between patient rankings of adverse events (AEs) with decision-making and quality of life outcomes and to determine if their perspective about AEs changes over time.
Being tested
Open, Robotic, or Laparoscopic, Transvaginal Native Tissue Repair, Uphold™ LITE
Keywords
pelvic organ prolapse, POP, vault prolapse, cystocele, vaginal prolapse, post-hysterectomy vaginal prolapse
Medical subject headings
Visceral Prolapse, Pelvic Organ Prolapse, Cystocele, Uterine Prolapse

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Open, Robotic, or LaparoscopicProcedure or surgery

    Sacral Colpopexy is a surgery performed either through an incision in the abdomen or through several small incisions with the help of a laparoscope (a slender tube) or robot. The surgery is done with a permanent synthetic (man-made) mesh. The mesh is sutured (stitched) to the vagina and sacrum (tail bone) and is used as reinforcement. It provides additional support to weakened tissues and/or muscles.

  • Transvaginal Native Tissue RepairProcedure or surgery

    Transvaginal Native Tissue Repair is a surgery performed with an incision through the vagina (transvaginal). The surgery is done using both permanent and absorbable sutures (stitches), to support weakened tissue and/or muscles, and attach the top of the vagina to ligaments in the pelvis (either to the sacrospinous ligament or uterosacral ligament).

  • Uphold™ LITEProcedure or surgery

    Transvaginal Mesh Repair is a surgery performed with an incision through the vagina (transvaginal). The surgery is done with a permanent synthetic (man-made) mesh. The mesh is attached to ligaments in the pelvis and is used to reinforce natural tissue and/or muscles, which are no longer able to provide support to the vagina.

Study groups in NCT02676973
Study groupRoleWhat they receive
Sacral ColpopexyActive comparatorSacral Colpopexy performed via open, robotic, or laparoscopic procedure.
Receives: Procedure: Open, Robotic, or Laparoscopic
Transvaginal Native Tissue RepairActive comparatorTransvaginal Native Tissue Repair: Sacrospinous Ligament Suspension (SSLS) and Uterosacral Ligament Suspension (USLS)
Receives: Procedure: Transvaginal Native Tissue Repair
Apical Transvaginal Mesh RepairActive comparatorUphold™ LITE
Receives: Procedure: Uphold™ LITE

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants Considered Failures

    Failure was defined as any of the following: retreatment for prolapse, any POP-Q measure beyond the hymen, or presence of bother on PFDI vaginal bulge question. Under the permanent failure state assumption, the number of participants shown at each visit includes all participants who were still participating in the study or had a failure outcome prior their withdrawal. Similarly, the denominator number of participants for the cumulative failure at each visit includes all participants who were still participating in the study and attended the visit or had any failure outcome prior their withdrawal or missed visit.

    Measured: 6 months through 60 Months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Feb 2016 (estimated)
  2. Study start29 Feb 2016
  3. Primary completion28 Jul 2022
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
360 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02676973
Sponsor's protocol ID
27P01
Other IDs
1U01HD069031-01, 2U10HD041261, 2U10HD054215, 2U10HD041267, 1U10HD069006, 2U10HD054214, 1U10HD069013, 1U10HD069025
Acronym
ASPIRe
Status last verified
Aug 2026
First submitted
30 Nov 2015
Last updated
15 Sep 2026
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Menefee SA, Richter HE, Myers D, Moalli P, Weidner AC, Harvie HS, Rahn DD, Meriwether KV, Paraiso MFR, Whitworth R, Mazloomdoost D, Thomas S; NICHD Pelvic Floor Disorders Network. Apical Suspension Repair for Vaginal Vault Prolapse: A Randomized Clinical Trial. JAMA Surg. 2024 Aug 1;159(8):845-855. doi: 10.1001/jamasurg.2024.1206.

    PubMed 38776067
  • Sung VW, Menefee S, Richter HE, Moalli PA, Andy U, Weidner A, Rahn DD, Paraiso MF, Jeney SE, Mazloomdoost D, Gilbert J, Whitworth R, Thomas S; Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Patient perspectives in adverse event reporting after vaginal apical prolapse surgery. Am J Obstet Gynecol. 2024 Aug;231(2):268.e1-268.e16. doi: 10.1016/j.ajog.2024.04.043. Epub 2024 May 6.

    PubMed 38710268
  • Sung VW, Menefee S, Dunivan G, Richter HE, Moalli P, Weidner A, Andy UU, Jelovsek E, Mazloomdoost D, Whitworth R, Thomas S; NICHD Pelvic Floor Disorders Network. Design of a Study to Measure Patient-Perspectives in Adverse Event Reporting (the PPAR Study): Supplementary Study to the ASPIRe Trial. Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e112-e117. doi: 10.1097/SPV.0000000000000845.

    PubMed 32487881
  • Menefee S, Richter HE, Myers D, Weidner A, Moalli P, Harvie H, Rahn D, Jeppson P, Paraiso M, Thomas S, Mazloomdoost D; NICHD Pelvic Floor Disorders Network. Design of a 3-Arm Randomized Trial for Posthysterectomy Vault Prolapse Involving Sacral Colpopexy, Transvaginal Mesh, and Native Tissue Apical Repair: The Apical Suspension Repair for Vault Prolapse in a Three-Arm Randomized Trial. Female Pelvic Med Reconstr Surg. 2020 Jul;26(7):415-424. doi: 10.1097/SPV.0000000000000803.

    PubMed 31860566

Questions about this trial

What is this clinical trial studying?

A study testing Open, Robotic, or Laparoscopic, Transvaginal Native Tissue Repair and Uphold™ LITE in people with Visceral Prolapse, run by NICHD Pelvic Floor Disorders Network at 10 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 15 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 17 May 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants Considered Failures (time frame: 6 months through 60 Months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02676973, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Sep 2026.

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