An interventional study of Horizontal Vaginal Cuff Closure Technique and Vertical Vaginal Cuff Closure Technique in Prolapse, Vaginal and Vaginal Vault Prolapse, sponsored by Gaziosmanpasa Research and Education Hospital. Recruiting at 1 site in Turkey (Türkiye). Open to female participants aged 35 Years to 65 Years. Per ClinicalTrials.gov, last updated 2025-07-16.
Sponsored by Gaziosmanpasa Research and Education Hospital · Not applicable, Interventional, and Treatment
This prospective clinical study aims to evaluate the impact of vaginal cuff closure orientation-horizontal versus vertical-on postoperative total vaginal length in patients undergoing vaginal hysterectomy combined with lateral suspension. By comparing anatomical outcomes between the two closure techniques, the study seeks to determine which method better preserves vaginal length, potentially influencing surgical preferences and postoperative quality of life.
This prospective clinical study is designed to evaluate the effect of vaginal cuff closure orientation-horizontal versus vertical-on postoperative total vaginal length in patients undergoing vaginal hysterectomy with lateral suspension. Vaginal length is a significant factor in pelvic floor support, sexual function, and patient satisfaction after pelvic organ prolapse surgeries.
Eligible patients undergoing vaginal hysterectomy and lateral suspension for uterine prolapse will be randomly assigned to two groups based on the vaginal cuff closure technique: Group 1 (horizontal closure) and Group 2 (vertical closure). All surgeries will be performed by the same surgical team to minimize technique-related variability. Preoperative and postoperative total vaginal lengths will be measured via standardized pelvic examination and recorded.
Secondary outcomes will include patient-reported symptoms (e.g., sensation of vaginal shortening, sexual function), surgical duration, intraoperative complications, and early postoperative outcomes. The study aims to provide evidence-based guidance on optimal vaginal cuff closure technique in uterovaginal prolapse surgery, with an emphasis on preserving vaginal length and improving postoperative quality of life.
111 studies on the registry are indexed under Uterine Prolapse; 20 are open to participants now.
This study's planned enrollment of 62 is below the median of 70 across 81 interventional studies indexed under Uterine Prolapse.
Browse Uterine Prolapse studies →Gaziosmanpasa Research and Education Hospital is the lead sponsor of 122 studies on the registry; 29 are open to participants now.
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Exclusion Criteria:
Patients who will not be able to comply with the follow-up process. Not accepting to participate in the study or not signing the informed consent form
Patients in this group will undergo vaginal hysterectomy with lateral suspension, followed by horizontal closure of the vaginal cuff using standard suturing technique. The effect on postoperative total vaginal length will be evaluated.
Procedure: Horizontal Vaginal Cuff Closure Technique
Patients in this group will undergo vaginal hysterectomy with lateral suspension, followed by vertical closure of the vaginal cuff using standard suturing technique. Postoperative vaginal length outcomes will be compared to those of the horizontal closure group.
Procedure: Vertical Vaginal Cuff Closure Technique
In this arm, patients undergoing vaginal hysterectomy with lateral suspension will receive horizontal closure of the vaginal cuff. After removal of the uterus, the vaginal cuff is closed in a transverse (right-to-left) direction using standard absorbable sutures. The technique aims to maintain or optimize the anatomical axis and preserve vaginal length in the horizontal plane. The entire procedure is performed under general or regional anesthesia by an experienced surgical team.
In this arm, patients undergoing vaginal hysterectomy with lateral suspension will receive vertical closure of the vaginal cuff. After the uterus is removed, the vaginal cuff is closed in a cranio-caudal (top-to-bottom) orientation using absorbable sutures. This technique is hypothesized to better support apical structures and reduce tissue tension. Procedures are performed under general or regional anesthesia with standardized operative technique.
Pelvic Organ Prolapse Quantification (POP-Q) Score
POP-Q scores will be used to assess anatomical outcomes of the pelvic support structures before and after surgery. Standardized POP-Q measurements (Aa, Ba, C, D, Ap, Bp, gh, pb, tvl) will be recorded preoperatively, 3 and 6 months postoperatively by blinded examiners. The primary focus will be on point C (vaginal apex) and total vaginal length (TVL) for comparison between groups.
Time frame: Baseline, 3 and 6 months postoperatively
PISQ-12 Questionnaire Score
The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) will be administered to sexually active patients preoperatively, 3 and 6 months postoperatively to assess sexual function and satisfaction. Changes in the total PISQ-12 score will be analyzed between the horizontal and vertical closure groups.
Time frame: Baseline, 3 and 6 months postoperatively
Plan to share: No
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Gaziosmanpasa Research and Education Hospital