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Objective: Our objective was to perform a 5‐year cost‐effectiveness analysis of transvaginal hysteropexy (HP) via sacrospinous ligament fixation (SS) or uterosacral ligament suspension (US) versus vaginal hysterectomy (VH) with apical suspension via sacrospinous ligament fixation (SS) or uterosacral ligament suspension (US) for the treatment of uterine prolapse. Design: A decision analytic model assessed the cost‐effectiveness of the surgical intervention over a 5‐year horizon. Setting: This model was constructed using TreeAge® software. Population or Sample: Healthy women undergoing surgery for uterine prolapse were modeled. Methods: A Markov model was constructed to simulate the possible recurrence of prolapse. Recurrence rates, repeat surgery for surgical failures and complication rates were modeled. Base case, sensitivity analyses and probabilistic modeling were performed. Main Outcome Measures: The primary outcome was the incremental cost‐effectiveness ratio (ICER) of <$100 000 per quality‐adjusted life year (QALY). Results: Using the available prolapse recurrence rates and repeat surgery rates in the literature, both HP‐SS and HP‐US are cost‐effective at a willingness‐to‐pay (WTP) threshold of <$100 000 per QALY. The incremental cost‐effectiveness ratio (ICER) for HP‐US compared to HP‐SS is $90 738.14, while VH‐US and VH‐SS are both dominated strategies. HP‐US is the optimal cost‐effective strategy but decays exponentially with increasing probability of prolapse recurrence and need for repeat surgery after failed hysteropexy. The cost‐effectiveness acceptability curve (CEAC) favors sacrospinous hysteropexy until reaching a WTP threshold between $90 000 and $100 000. Conclusion: Hysteropexy surgical strategies are cost‐effective transvaginal surgical approaches for uterine prolapse. Vaginal hysterectomy with apical suspension becomes more cost‐effective with increasing probability of prolapse recurrence and need for repeat surgery after failed hysteropexy. Given the variability of prolapse recurrence rates in the literature, more comparative studies are needed to understand the cost‐effectiveness relationship between these different surgical approaches. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Robust data comparing the timing of voiding trials following prolapse surgery are lacking. Filling in these knowledge gaps would be helpful in counseling patients preoperatively about the concerns regarding same-day discharge. We aimed to compare the rate of a failed void trial after apical pelvic organ prolapse (POP) repair between patients who were discharged on the day of surgery versus those discharged on postoperative day 1. Methods: This was a retrospective matched case–control study of women who underwent either a laparoscopic/robotic or transvaginal apical POP surgery with or without concurrent hysterectomy. Patients who were discharged on postoperative day 0 (POD0) were identified as cases and matched to control patients discharged on postoperative day 1 (POD1). Patients were matched 1:1 based on age and surgical approach. Results: A total of 59 patients in each group met the inclusion criteria. Of the entire cohort, 34 (28.8%) patients failed their void trial, with no statistically significant difference between those who were discharged on POD0 versus POD1 (33.9% vs 23.7%, p=0.47). Patients who were discharged on POD0 were more likely to be diagnosed with a urinary tract infection (22.0% vs 8.4%, p=0.041) during the postoperative period. Conclusions: In patients undergoing surgery for apical prolapse, there was no difference in the rate of void trial failure in those who had a catheter removal on the day of surgery compared with those who experienced removal the following day. [ABSTRACT FROM AUTHOR]