Surgical Treatment of Vaginal Vault Prolapse

Abstract

In Brief Objectives This study aimed to review the history of surgical treatment of vaginal vault prolapse, its current treatments, and its outcomes. Methods A PubMed search was conducted using the following terms: vaginal vault prolapse, apical prolapse, surgical treatments, culdoplasty, uterosacral ligament fixation, and sacral colpopexy. Results Vaginal vault prolapse is a common condition with many surgical treatment options. Surgical principles and treatment of this condition dates back to the 19th century. Native tissue repairs such as McCall culdoplasty, uterosacral ligament fixation, and sacrospinous fixation have high overall success rates with restoring apical anatomy. Sacral colpopexy also has excellent success rates when mesh is needed to augment repairs. Conclusions There are many options for the treatment of vaginal vault prolapse. Modifications have been made to the original procedures; however, the basic principles are still applicable and include attaching the vaginal apex to level 1 support. Vaginal vault prolapse can be treated with a variety of surgical techniques using vaginal, abdominal, or laparoscopic/robotic routes. Commonly used techniques include McCall culdoplasty, uterosacral suspension, sacrospinous fixation, and ileococcygeal suspension.