[Genital prolapse surgery: state of the art of the vaginal approach].

Treatment of genital prolapse is mainly surgical. The vaginal approach is a shorter procedure than the abdominal approach with a quicker resumption of activity for the patients. We describe different techniques which are most often performed in our daily practice. For the complete prolapse affecting the three components of the pelvic floor, we most often associate a colpohysterectomy, a native tissue reinforcement for the treatment of cystocele, sub-symphyseal crossing of the uterosacral ligaments using the technique of Campbell and finally a suspension of the vaginal vault according to Richter with a levator myorraphy. Currently, native tissues used in these techniques tend to be superseded in our service by reinforcement prosthetic implants, which according to the latest French Health Higher Authority guidelines (November 14, 2007) "could be of interest in relapse surgery, if a clinical element raises fears of high risk of recurrence." In any case, patients seeking a surgical treatment of their genital prolapse must be fully informed of the specific risk related to each technique. They must also be informed of the long-term results or of the lack of available data, regarding techniques using native tissue or prostheses.