Purpose of review
This article reviews the current literature regarding surgical repair of vaginal
apical prolapse and discusses the risks and benefits of various surgical approaches.
Recent findings
Vaginal uterosacral ligament suspension has similar anatomic and subjective outcomes to sacrospinous ligament fixation at 1 year. Native tissue vaginal repairs offer decreased morbidity compared with mesh-augmented
sacrocolpopexy; however,
sacrocolpopexy has greater anatomic success. Minimally invasive
sacrocolpopexy appears to be equivalent to open abdominal
sacrocolpopexy. Native tissue repairs and transvaginal mesh kits support the vaginal apex with similar results; however, long-term follow-up is needed. Robotic and laparoscopic
sacrocolpopexy are equally effective in restoring the vaginal apex.
Summary
Surgical restoration of the vaginal apex can be accomplished via a variety of approaches and techniques. When deciding on the proper surgical intervention, the surgeon must carefully calculate the risks and benefits of each procedure while incorporating the patient's individual medical and surgical risk factors. Lastly, a discussion regarding the patient's overall goals of care is paramount to the decision-making process.
