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In Reply Dr Fujita suggests that despite abdominal sacrocolpopexy being less effective than desired, it should still be considered a standard operation for upper vaginal prolapse. We agree. However, the fact that abdominal sacrocolpopexy is more effective than the vaginal surgeries to which it has been compared in randomized trials does not mean that it should be the initial procedure of choice for most women with apical prolapse. It is remarkable that since 1996, there have been only 5 small randomized trials (2 of them to date presented only as abstracts) comprising in total fewer than 500 women.1
Nygaard I. Surgery for Pelvic Organ Prolapse—Reply. JAMA. 2013;310(10):1073-1074. doi:10.1001/jama.2013.238044