Repair of vaginal vault prolapse and pelvic floor relaxation using polypropylene mesh

Innumerable techniques have been described for vaginal vault prolapse and enterocele repair including abdominal (open, laparoscopic, and robotic) and vaginal techniques. Recently, the use of surgical mesh in pelvic floor surgery has become increasingly popular due to the high incidence of recurrence with primary repairs and no surrogate material. The increasing variety of available materials and techniques, combined with a lack of well conducted clinical trials, make the choice of repair to use difficult.

This article provides an update review on the different procedures available to the urogynecologist and female urologist for repair of vault prolapse. We will also discuss a new surgical technique for the repair of vault prolapse, which recreates the sacrouterine-cardinal ligament complex and reconstructs the pelvic floor with mesh.

The best approach to vaginal vault prolapse remains unknown. Surgeon comfort and preference as well as proper patient selection remain critical. The use of graft materials in pelvic floor reconstruction should have limited use in a carefully selected patient population. There is a need for well powered, controlled, long-term, randomized studies with patient generated quality-of-life questionnaires comparing the short and long-term outcomes of these techniques.