Surgical treatment of apical prolapse Number 9 - 2026.

Apical genital prolapse represents a failure of DeLancey's level I support. Isolated vaginal hysterectomy does not correct apical prolapse. All surgery for uterine or vaginal vault prolapse should include apical suspension. Sacrocolpopexy is the most durable technique for correcting vaginal vault prolapse, with the exception of colpocleisis. Vaginal techniques remain valid options in selected patients. Uterine preservation, when based on shared decision-making, is possible and safe for carefully evaluated patients. Recognition of the apical component in advanced cystocele is essential to prevent recurrence. Correction of the genital hiatus reduces the risk of recurrence, regardless of the surgical approach. Intraoperative cystoscopy is mandatory in vaginal uterosacral suspensions. Concomitant correction of stress urinary incontinence should be considered when diagnosed clinically or functionally.