Uterosacral Ligament Suspension (USLS)

Bilateral suspension of the vaginal apex to the uterosacral ligaments at the level of the ischial spines, restoring apical support along a more anatomic axis than SSLF. The OPTIMAL trial showed 63.1% success vs 64.5% for SSLF at 2 years. Mandatory intraoperative cystoscopy required given risk of ureteral kinking from high uterosacral suture placement.