Strengths and limitations
pelvic organ prolapse
We performed a randomized controlled trial, which is considered to yield the highest level of evidence when comparing two different treatment options. One of the main strengths of our study is the duration of follow-up, with a median of 109 months (9.1 years), which may be stated as “very long” (> 5 years) duration of follow-up, according to the IUGA/ICS joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse [One of the limitations of our study is the relatively high rate of loss to follow-up. However, the statistical power remains >80% for the primary outcome measure disease-specific quality of life. From the 36 eligible patients in the LSC group, 14 patients (38.9%) were lost to follow-up, compared with 16 (45.7%) of the 35 eligible participants in the ASC group. Nine patients died and eight patients were not able to participate owing to old age or serious health issues, which was beyond our control. Perhaps the SARS-CoV-2 pandemic added to the loss to follow-up; however, we have no complete data on this matter. Other studies reported attrition rates of 46% at 5 years [Most of our study population were postmenopausal and multiparous, with two or more vaginal births. This makes our results mainly applicable for patients with comparable characteristics.