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Abstract
The pelvic floor consists of the levator muscles and attached fascial tissues, which work in concert to support the pelvic organs. Deterioration of the supportive network that specifically involves the uterosacral-cardinal ligament complex can result in apical vault prolapse. Further descent of the vagina can compromise the lateral attachments of both the pubocervical and rectovaginal fasciae to the arcus tendineus fasciae pelvis, or white line. These defects often coexist, with failure of the mid-urethral support culminating in urinary incontinence.
Surgical treatment of vault prolapse is historically the most effective treatment. Traditional vaginal vault surgeries include McCall culdoplasty, uterosacral ligament suspension, iliococcygeus suspension, sacrospinous fixation, posterior intravaginal slingplasty vault suspension, and abdominal sacrocolpopexy. Vaginal surgery offers less morbidity and pain and faster recovery than other approaches while the abdominal approach to vaginal repair has been associated with greater cure rates. The challenge becomes achieving the durability of the abdominal approach while preserving the minimally invasive nature of the vaginal approach. Recent innovative approaches to vaginal wall repair use minimally invasive techniques to implant either polypropylene mesh or xenografts in a tension-free manner to achieve this equation.