title: Apical prolapse repair: weighing the risks and benefits.
abstract: OBJECTIVE
  This article reviews the current literature regarding surgical repair of vaginal apical prolapse and discusses the risks and benefits of various surgical approaches.
  
  
  RESULTS
  Vaginal uterosacral ligament suspension has similar anatomic and subjective outcomes to sacrospinous ligament fixation at 1 year. Native tissue vaginal repairs offer decreased morbidity compared with mesh-augmented sacrocolpopexy; however, sacrocolpopexy has greater anatomic success. Minimally invasive sacrocolpopexy appears to be equivalent to open abdominal sacrocolpopexy. Native tissue repairs and transvaginal mesh kits support the vaginal apex with similar results; however, long-term follow-up is needed. Robotic and laparoscopic sacrocolpopexy are equally effective in restoring the vaginal apex.
  
  
  CONCLUSIONS
  Surgical restoration of the vaginal apex can be accomplished via a variety of approaches and techniques. When deciding on the proper surgical intervention, the surgeon must carefully calculate the risks and benefits of each procedure while incorporating the patient's individual medical and surgical risk factors. Lastly, a discussion regarding the patient's overall goals of care is paramount to the decision-making process.
authors: Department of Urogynecology, Pelvic Reconstructive Surgery, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Audra Jolyn
authors: AJ
authors: Hill
authors: Matthew D
authors: MD
authors: Barber
mesh_terms: D003657:Decision Making; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D018579:Patient Selection; D056887:Pelvic Organ Prolapse / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome; D014621:Vagina / Q000473:pathology / Q000601:surgery*