title: Role of apical support defect: correction in women undergoing vaginal prolapse surgery.
abstract: OBJECTIVE
  The aim was to review most recent literature and provide updates in clinical management and surgical treatment of apical pelvic organ prolapse.
  
  
  RESULTS
  In patients who decline surgical intervention, formal referral to pelvic floor muscle training is beneficial over self-directed Kegel exercises. Systematic reviews revealed that sacrocolpopexy has better long-term outcomes than vaginal approaches. Uterosacral ligament suspension and sacrospinous ligament suspension have equal efficacy at 1 year. These procedures should be considered as acceptable alternatives to sacrocolpopexy. Two randomized controlled trials have demonstrated equal efficacy between robotic and laparoscopic sacrocolpopexy.
  
  
  CONCLUSIONS
  Minimally invasive sacrocolpopexy should be considered the gold standard for apical prolapse, but these techniques are associated with longer operating times and higher complication rates and longer convalescence than nonmesh vaginal surgery. Surgeons must individualize surgical technique for each patient and should consider a vaginal approach in patients who do not desire laparotomy and are not candidates for minimally invasive surgery.
authors.affiliation: aDepartment of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, Weston, FL bDepartment of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Alexandriah N
authors.initials: AN
authors.lastname: Alas
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
mesh_terms: D003075:Coitus; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D056887:Pelvic Organ Prolapse / Q000503:physiopathology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome