Surgical management of uterine prolapse

The surgical management of uterine prolapse requires an apical suspension procedure, with or without uterine removal. Options in the surgical treatment of uterine prolapse encompass the open, laparoscopic, or vaginal approaches. Vaginal apical suspension procedures include the uterosacral vaginal vault suspension, sacrospinous ligament fixation, iliococcygeus fascia suspension, and the McCall or Mayo culdoplasty. The abdominal sacral colpopexy may be performed via laparotomy or laparoscopy. Uterine preservation techniques include the Manchester procedure, sacrospinous hysteropexy, laparoscopic sacral hysteropexy and laparoscopic uterosacral vault suspension. Most of the data for subjective and objective outcomes for these prolapse procedures are from uncontrolled retrospective case series. Currently there is no definitive gold standard procedure to favor a particular route in the treatment of uterine prolapse. Thus, the optimal procedure to treat uterine prolapse depends on the specific defects that are present, as well as considerations such as the patient's age, comorbidities, activity level, desire for future fertility, history of prior prolapse surgery in other compartments, patient preference, as well as the skill and comfort level of the surgeon with the particular surgery.