Dear Editor,

I have read with great interest the study on the effectiveness of two different surgical procedures for the treatment of Pelvic Organ Prolapse (POP) in improving patients' symptoms and preventing disease recurrence. However, I would like to express some concerns regarding the article.

Primarily, although not explicitly stated in the title and abstract, upon closer examination, it is apparent that uterosacral ligament suspension was performed simultaneously with vaginal hysterectomy to provide the patients with concurrent apical support.

Furthermore, it is reported that patients who underwent sacrospinous hysteropexy with preservation of the uterus had an average age that was 5 years older than those in the group who underwent vaginal hysterectomy, which is statistically significant. This presents a significant confounding factor, particularly regarding the improvement in quality of life and sexual function [1]. Perhaps as a reflection of this, the number of sexually active patients in the hysteropexy group decreased postoperatively, contrary to expectations.

Another confounding factor is the hysterectomy itself. Although it is known that patients generally experience an improvement in quality of life and sexual function after POP surgery, comparing the effectiveness of two surgical procedures—where one involves hysterectomy and the other does not, such as hysteropexy—could lead to misinterpretations [2].

Indeed, the most intriguing and unanswered question in the article is how the decision between vaginal hysterectomy and hysteropexy was made for the patients. The article does not specify the criteria used for surgical procedure selection. Generally, the uterus-preserving hysteropexy procedure is recommended for relatively younger patients or those with comorbidities, in whom a shorter operation time is desired [3, 4]. Upon reviewing the data in the article, it is noted that the authors predominantly opted for vaginal hysterectomy for patients with apical prolapse (C point ≥ stage 2), and this preference reached statistical significance.