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To evaluate the 10‐year outcomes of high uterosacral ligament suspension as a primary repair for apical prolapse and to assess the long‐term impact of prognostic factors. A total of 287 women were analyzed. Ten‐year recurrence rates were 19.1% for objective recurrence and 6.3% for subjective recurrence; the surgical retreatment rate was 2.1%. Premenopausal status was related to a 15‐fold increased risk of developing either objective or subjective repeat. High uterosacral ligament suspension is a safe, long-lasting, effective procedure for treating uterovaginal prolapse even 10 years after index surgery. Premenopausal status and lack of anterior and posterior repair represented long‐term risk factors for surgical failure.
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