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Prolapse GenitalFIMEANCT07194343

Posterior Mesh Fixation at the Levator Ani Level in Apical Pelvic Organ Prolapse

A study testing Laparoscopic colposacropexy with levator ani muscle mesh fixation and Simplified modification of laparoscopic colposacropexy in people with Prolapse Genital and Prolapse Uterovaginal, run by Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau at 6 sites in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

This is a prospective, randomized, multicenter, non-inferiority trial including women with stage II-IV apical pelvic organ prolapse (POP), classified according to the POP-Q system. Read more about this study

Who is it for?
Ages 18 years and older, women only
What is being tested?
Laparoscopic colposacropexy with levator ani muscle mesh fixation and Simplified modification of laparoscopic colposacropexy
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
190 participants
Where
6 sitesSpain
Study dates
6 Oct 2022to 31 Oct 2025
Phase
Interventional
Are there results?
None posted in the registry

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

Who may be able to join

  • Women with primary or recurrent apical prolapse (uterine or vaginal vault) stage II-IV according to the POP-Q classification.
  • Women with symptomatic POP with indication of reconstructive POP surgery.
  • Agreement to comply with all scheduled visits and assessments through 12 months post-surgery.
  • Understand and accept the study procedures and sign the informed consent.

Who cannot join

  • History of abdominal reconstructive surgery for pelvic organ prolapse.
  • History of vaginal reconstructive surgery for prolapse using mesh.
  • Stage I prolapse according to the POP-Q classification, or asymptomatic prolapse.
  • Medical contraindication to general anesthesia.
  • Patient preference for vaginal surgical treatment.
  • Declines participation in the study.
  • Patients with disabilities or unable to understand the terms of the study.

Trial locations and contacts

6 sites in 1 country.

6 sites in 1 country

Spain6 sites
  • Hospital de la Santa Creu i Sant Pau

    Barcelona, Barcelona

  • Hospital Universitari Dexeus

    Barcelona, Barcelona

  • Hospital Universitari d'Igualada

    Igualada, Barcelona

  • Hospital Clinico Universitario Virgen de la Arrixaca

    Murcia

  • Hospital Universitario Infanta Sofia

    San Sebastián de los Reyes, Madrid

  • Hospital General Universitario de Valencia

    Valencia, Valencia

Other trials in Spain

About this study

Official title: Multicenter Study on Levator Ani Muscle Fixation in Laparoscopic Colposacropexy (FIMEA Multicenter Study)

This is a prospective, randomized, multicenter, non-inferiority trial including women with stage II-IV apical pelvic organ prolapse (POP), classified according to the POP-Q system. Participants will be randomized into two groups:

Group A: laparoscopic colposacropexy with posterior mesh fixation to the levator ani muscle.

Read more

Group B: laparoscopic colposacropexy with posterior mesh fixation to the vaginal cuff/cervix, without dissection of the rectovaginal space.

The objective of the study is to determine whether a simplified colposacropexy technique is non-inferior to the standard procedure in terms of anatomical and functional outcomes.

The primary outcome is anatomical success, defined as a postoperative POP-Q stage 0-I. Secondary outcomes include functional status and sexual function, evaluated using the PFDI-20 and PISQ-12 questionnaires. Data on prolapse anatomy, related symptoms, and sexual function will be collected at baseline and during follow-up visits at 1, 6, and 12 months after surgery.

This study is supported by a national health research grant from the Instituto de Salud Carlos III (ISCIII), Ministry of Science and Innovation, Spain.

Read the detailed description

This study is a multicenter, randomized, controlled, evaluator-blinded, non-inferiority clinical trial. The null hypothesis is that colposacropexy with posterior mesh fixation to the vaginal vault (without rectovaginal dissection) is associated with an anatomical and/or functional failure rate that is equal to or more than 15% higher than colposacropexy with posterior mesh fixation to the levator ani muscle (deep rectovaginal dissection). A non-inferiority margin of 15% has been selected because smaller differences are not considered clinically relevant.

With this project, the investigators aim to evaluate the outcomes of a simplified colposacropexy technique that avoids dissection of the rectovaginal space and deep pelvic mesh fixation. Demonstrating non-inferiority would imply rejecting the null hypothesis.

The procedure is indicated for women with stage II-IV uterine or vault prolapse according to the POP-Q classification, with or without associated anterior and/or posterior vaginal wall defects. The decision to perform surgery will be made by the gynecologists, independent of trial participation, to ensure that study enrollment does not influence standard surgical indications. Exclusion criteria include previous abdominal or vaginal mesh prolapse reconstructive surgery or POP-Q stage I or asymptomatic prolapse.

Sample size calculations assume a 91% success rate for the standardized procedure (Lee 2014), a non-inferiority margin of 15%, a 95% confidence interval, and 80% statistical power. A total of 166 patients (83 per group) are required, accounting for a 10% dropout rate.

DESCRIPTION OF THE SURGICAL TECHNIQUE

The vesicovaginal dissection and exposure of the sacral promontory will be performed identically in both groups. A predesigned polypropylene mesh will be used, consisting of:

  • an apical end for fixation to the sacral promontory,
  • two lateral arms shaped like "butterfly wings" to cover and support the anterior and lateral vaginal walls,
  • and two lower arms designed for fixation to the levator ani muscle.

Fixation of the mesh to the vagina, sacral promontory, and (when applicable) the levator ani muscle will be performed using nitinol helical mechanical sutures (Spire'it). At the vesicovaginal space, the mesh will be anchored at the anatomical depth corresponding to the vesical neck level in both groups.

The only difference between groups involves the posterior compartment dissection and mesh fixation:

  • Group A (standard technique): the posterior arms of the mesh are anchored bilaterally to the levator ani muscle with mechanical sutures.
  • Group B (simplified technique): the posterior arms are removed, and the mesh is anchored only to the vaginal vault or cervix with mechanical sutures, without rectovaginal dissection.
Being tested
Laparoscopic colposacropexy with levator ani muscle mesh fixation, Simplified modification of laparoscopic colposacropexy
Keywords
pelvic organ prolapse, apical prolapse, laparoscopic colposacropexy, mesh fixation, levator ani muscle, surgical outcomes, functional outcomes, anatomical outcomes, sexual function
Medical subject headings
Prolapse, Pelvic Organ Prolapse

What participants receive

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

  • Laparoscopic colposacropexy with levator ani muscle mesh fixationProcedure or surgery

    The standard technique includes dissection of the rectovaginal space and bilateral mesh fixation to the levator ani muscle at the deep limit of the pararectal fossae dissection.

  • Simplified modification of laparoscopic colposacropexyProcedure or surgery

    Rectovaginal dissection is avoided, and the mesh is anchored to the posterior aspect of the cervix or vaginal vault rather than to the levator ani muscle, representing the specific modification from the standard technique.

Study groups in NCT07194343
Study groupRoleWhat they receive
Group A: Standard laparoscopic colposacropexyActive comparatorThe procedure is based on the laparoscopic colposacropexy technique described by Wattiez in 2001 (Clermont-Ferrand group). The standard technique includes dissection of the sacral promontory, the vesicovaginal space, and the rectovaginal space with bilateral pararectal fossae. In the vesicovaginal space, the mesh is anchored deeply at the level of the vesical neck, and posteriorly, in the rectovaginal and pararectal spaces, at the level of the levator ani muscle.
Receives: Procedure: Laparoscopic colposacropexy with levator ani muscle mesh fixation
Group B: Simplified laparoscopic colposacropexyExperimentalThe simplified technique includes dissection of the sacral promontory and the vesicovaginal space, but does not involve dissection of the rectovaginal space or the pararectal fossae. In this technique, the posterior mesh is anchored to the posterior aspect of the vaginal vault or cervix. Mesh fixation at the sacral promontory and in the vesicovaginal space is performed within the same anatomical boundaries as in the standard technique.
Receives: Procedure: Simplified modification of laparoscopic colposacropexy

What is being measured

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

  1. Difference in anatomical success rate between simplified (Group B) and standard (Group A) laparoscopic colposacropexy.

    Proportion of participants achieving anatomical success, defined as postoperative POP-Q stage 0-I. The primary analysis will test non-inferiority of the simplified technique (Group B) versus the standard technique (Group A). Non-inferiority will be concluded if the lower bound of the two-sided 95% confidence interval for (Success_B - Success_A) is greater than 15% (non-inferiority margin = 15%). POP-Q assessment will be performed using standardized technique by an evaluator blinded to surgical assignment.

    Measured: 12 months after surgery

Secondary outcomes (2)
  1. Difference in functional outcomes between simplified (Group B) and standard (Group A) laparoscopic colposacropexy.

    Functional outcomes will be assessed by validated questionnaire: Pelvic Floor Distress Inventory-20 (PFDI-20). Scores will be compared between groups to evaluate whether the simplified technique results in inferior functional outcomes compared with the standard technique in women with stage II-IV apical prolapse.

    PFDI-20 consists of 20 items divided into three subdomains:

    • Pelvic Organ Prolapse Distress Inventory (POPDI-6): Score range: 0 to 24.
    • Colorectal-Anal Distress Inventory (CRADI-8): Score range: 0 to 32.
    • Urinary Distress Inventory (UDI-6): Score range: 0 to 24. Each item is scored from 0 (no distress) to 4 (quite a bit of distress). Subdomain scores are calculated by summing the responses within each section. The total PFDI-20 score is the sum of all three subdomains, with a possible global score ranging from 0 to 80. Higher scores indicate greater symptom severity and higher levels of distress caused by pelvic floor disorders.

    Measured: 12 months after surgery

  2. Difference in sexual outcomes between simplified (Group B) and standard (Group A) laparoscopic colposacropexy.

    Sexual outcomes will be assessed by validated questionnaire: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12). Scores will be compared between groups to evaluate whether the simplified technique results in inferior sexual outcomes compared with the standard technique in women with stage II-IV apical prolapse.

    The PISQ-12 is a validated, condition-specific questionnaire used to assess sexual function in women with pelvic organ prolapse and urinary incontinence. It consists of 12 items covering three domains:

    • Behavioral-Emotional Domain
    • Physical Domain
    • Partner-Related Domain Each item is scored on a scale from 0 to 4 and the total PISQ-12 score ranges from 0 to 48. A higher total score reflects better sexual function and quality of sexual life, while lower scores indicate greater sexual dysfunction related to pelvic floor disorders.

    Measured: 12 months after surgery

Timeline

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

  1. First posted26 Sep 2025
  2. Study start6 Oct 2022
  3. Primary completion31 Oct 2025
  4. Study completion31 Oct 2025

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
Model description
Group A: Laparoscopic colposacropexy with posterior mesh fixation to the levator ani muscle (standard technique). Group B: Laparoscopic colposacropexy with posterior mesh fixation to the vaginal cuff or cervix, without rectovaginal space dissection (simplified technique).
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
190 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07194343
Sponsor's protocol ID
PI21/00852
Acronym
FIMEA
Status last verified
Nov 2025
First submitted
12 Sep 2025
Last updated
10 Feb 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: There are no current plans to share individual participant data (IPD). Data use is restricted to the investigators involved in this project, according to the informed consent provided by participants and ethical committee approval.

Publications

  • Kuroda K, Hamamoto K, Kawamura K, Masunaga A, Horiguchi A, Ito K. Device Selection Contributes to Operative Time Reduction in Laparoscopic Sacrocolpopexy. Gynecol Minim Invasive Ther. 2025 Mar 15;14(2):157-164. doi: 10.4103/gmit.gmit_155_23. eCollection 2025 Apr-Jun.

    PubMed 40521574
  • Schaub M, Lecointre L, Faller E, Boisrame T, Baldauf JJ, Wattiez A, Akladios CY. Laparoscopic Sacral Colpopexy: The "6-Points" Technique. J Minim Invasive Gynecol. 2017 Nov-Dec;24(7):1081-1082. doi: 10.1016/j.jmig.2017.04.003. Epub 2017 Apr 18.

    PubMed 28435129
  • Bataller E, Ros C, Angles S, Gallego M, Espuna-Pons M, Carmona F. Anatomical outcomes 1 year after pelvic organ prolapse surgery in patients with and without a uterus at a high risk of recurrence: a randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy and anterior vaginal mesh. Int Urogynecol J. 2019 Apr;30(4):545-555. doi: 10.1007/s00192-018-3702-7. Epub 2018 Jul 9.

    PubMed 29987345
  • Habib N, Centini G, Pizzoferrato AC, Bui C, Argay I, Bader G. Laparoscopic promontofixation: Where to stop the anterior dissection? Med Hypotheses. 2019 Mar;124:60-63. doi: 10.1016/j.mehy.2019.02.006. Epub 2019 Feb 2.

    PubMed 30798918
  • Cosma S, Petruzzelli P, Chiado Fiorio Tin M, Parisi S, Olearo E, Fassio F, Zizzo R, Danese S, Benedetto C. Simplified laparoscopic sacropexy avoiding deep vaginal dissection. Int J Gynaecol Obstet. 2018 Nov;143(2):239-245. doi: 10.1002/ijgo.12632. Epub 2018 Aug 24.

    PubMed 30076597
  • Moroni RM, Juliato CRT, Cosson M, Giraudet G, Brito LGO. Does sacrocolpopexy present heterogeneity in its surgical technique? A systematic review. Neurourol Urodyn. 2018 Nov;37(8):2335-2345. doi: 10.1002/nau.23764. Epub 2018 Jul 19.

    PubMed 30024069
  • Gluck O, Blaganje M, Veit-Rubin N, Phillips C, Deprest J, O'reilly B, But I, Moore R, Jeffery S, Haddad JM, Deval B. Laparoscopic sacrocolpopexy: A comprehensive literature review on current practice. Eur J Obstet Gynecol Reprod Biol. 2020 Feb;245:94-101. doi: 10.1016/j.ejogrb.2019.12.029. Epub 2019 Dec 26.

    PubMed 31891897
  • Costantini E, Brubaker L, Cervigni M, Matthews CA, O'Reilly BA, Rizk D, Giannitsas K, Maher CF. Sacrocolpopexy for pelvic organ prolapse: evidence-based review and recommendations. Eur J Obstet Gynecol Reprod Biol. 2016 Oct;205:60-5. doi: 10.1016/j.ejogrb.2016.07.503. Epub 2016 Aug 3.

    PubMed 27566224
  • Maher C, Yeung E, Haya N, Christmann-Schmid C, Mowat A, Chen Z, Baessler K. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2023 Jul 26;7(7):CD012376. doi: 10.1002/14651858.CD012376.pub2.

    PubMed 37493538

Questions about this trial

What is this clinical trial studying?

A study testing Laparoscopic colposacropexy with levator ani muscle mesh fixation and Simplified modification of laparoscopic colposacropexy in people with Prolapse Genital and Prolapse Uterovaginal, run by Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau at 6 sites in Spain.

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 4 inclusion and 7 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: finished, as of the sponsor's last update on 10 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in Spain. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Difference in anatomical success rate between simplified (Group B) and standard (Group A) laparoscopic colposacropexy. (time frame: 12 months after surgery). 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 NCT07194343, which also lists 9 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 10 Feb 2026.

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