Surgical techniques for vault prolapse: a review of the literature

We searched MEDLINE for articles indexed between 1972 and 2002 and dealing on operative techniques for vault prolapse. We found 149 articles describing, variously, abdominal sacrocolpopexy with mesh (2008 patients), other transabdominal methods (387 patients), sacrospinous ligament fixation (2390 patients), other transvaginal repairs (1556 patients), laparoscopic procedures (128 patients), intravaginal sling (168 patients) and vaginal obliteration techniques (157 patients). For each of these procedures there is a short presentation of the operative technique and a summary of all published data on concomitant surgery, complications and follow-up results relating to anatomical and functional outcome. Two procedures are more frequently used than the others: abdominal sacrocolpopexy and transvaginal sacrospinous ligament fixation. We were unable to detect any differences in the complication and/or cure rates, but did find a slightly better long-term anatomical outcome after the abdominal technique. Since no standardized outcome measure is available it is difficult to compare the functional results. Only in more recent studies have subjective cure rates (patient satisfaction with the outcome) also been evaluated as well as the objective cure rates determined by the investigators, and the objective and subjective rates are not necessarily the same. The subjective cure rate is probably more strongly influenced by the functional outcome in terms of micturition, defaecation and sexual activity than by the anatomical result.