腹腔镜下子宫腹壁悬吊联合阴道前壁修补治疗子宫脱垂84例病例分析

目的:分析腹腔镜下子宫腹壁悬吊联合阴道前壁修补术治疗子宫脱垂的有效性及安全性。方法:选择2014年1月至2018年12月因Ⅲ~Ⅳ度子宫脱垂且合并阴道前壁膨出于溧阳市人民医院就诊的患者共84例,采用腹腔镜下简易子宫腹壁悬吊+阴道前壁修补进行治疗,伴有阴道后壁膨出的患者术中同时行阴道后壁桥式修补。术后随访12~72月(平均36.8月),记录患者术中情况、手术并发症及手术前后盆腔器官脱垂定量分度(POP-Q)及盆底功能影响问卷简表(PFIQ-7)评分。结果:腹腔镜下子宫腹壁悬吊+阴道前壁修补术的手术时间为(47.75±6.73)min,术中出血量(49.41±14.44)ml,无术中脏器损伤。术后1年随访客观治愈率97.6%(82/84),手术并发症发生率7.14%(6/84)。术后1年POP-Q评分中Aa、Ba、C、Ap、Bp各点的值均较术前有明显改善。患者术前PFIQ-7评分(116.29±17.97)分,术后6月评分(25.31±10.15)分,术后1年评分(26.32±7.85)分,差异有统计学意义(P<0.01)。结论:腹腔镜下简易子宫腹壁悬吊联合阴道前壁修补术治疗子宫脱垂操作简单,容易掌握,近期有效率高。     

腹腔镜下阴道残端高位骶韧带悬吊与腹壁悬吊术治疗中盆腔缺陷的疗效比较

目的:探讨腹腔镜下高位骶韧带悬吊与腹壁悬吊术治疗中盆腔缺陷的疗效比较。方法:对2016年9月至2019年9月在徐州医科大学附属医院采用腹腔镜下阴道残端高位骶韧带悬吊术(研究组)60例与腹腔镜下阴道残端腹壁悬吊术(对照组)60例治疗的中盆腔缺陷患者的临床资料进行回顾性分析。采用盆腔器官脱垂定量(POP-Q)分度法,120例均为中盆腔缺陷为主且Ⅱ～Ⅲ度,年龄分别40～75岁,均为子宫脱垂初次手术患者,比较两组手术时间、术中出血量、住院费用、术后并发症、术前及术后12个月生活满意度随访,主观疗效评价采用盆底不适调查表简表(PFDI-20)。结果:研究组术后手术总体主观满意率达96.67%(58/60),研究组手术时间、术中出血量、住院费用分别为93.55±9.95 min、40.13±14.35 ml、12719.13±773.96元;对照组术后手术总体主观满意率达88.33%(53/60),对照组手术时间、术中出血量、住院费用分别为104.42±16.25 min、83.67±11.64 ml、14890.18±770.80元。两组手术时间、术中出血量、住院费用比较差异有统计学意义(P0.05),两组患者术后生活质量较术前明显改善(P0.05),术后两组患者生活质量比较差异无统计学意义(P0.05)。结论:腹腔镜下阴道残端高位骶韧带悬吊与阴道残端腹壁悬吊术对中盆腔缺陷疗效明显,因阴道残端高位骶韧带悬吊术较阴道残端腹壁悬吊术,手术时间短、出血少、住院费用低及术后并发症较少,值得临床推广应用。     

腹腔镜下全子宫切除联合高位宫骶韧带悬吊术治疗子宫脱垂的疗效分析

目的 探讨腹腔镜下全子宫切除联合高位宫骶韧带悬吊术治疗子宫脱垂的临床疗效及其对性生活的影响.方法 选取72例接受手术治疗的盆腔器官脱垂定量(POP-Q)分度Ⅱ ～ Ⅲ度子宫脱垂伴(不伴)阴道前后壁膨出患者,采用随机数字表法分为研究组与对照组,每组36例.研究组患者接受腹腔镜下全子宫切除联合高位宫骶韧带悬吊术,对照组患者...     

子宫脱垂的腹腔镜手术治疗进展

子宫脱垂是一种常见的妇科疾病。子宫脱垂的病因是多因素的,包括神经肌肉功能障碍和盆底筋膜的缺陷。近年随着腹腔镜技术在妇科手术中的应用及补片材料的研发应用,使腹腔镜下治疗子宫脱垂并保留子宫成为可能。出现多种术式变化,如腹腔镜下子宫圆韧带悬吊术、子宫骶骨岬固定术、宫骶韧带缩短术等。由于腹腔镜技术具有视野开阔、创伤小、术后恢复快、住院时间短等优点,使其成为近年研究的热点。     

腹腔镜高位骶韧带联合圆韧带悬吊术治疗子宫脱垂的临床效果分析

目的探讨腹腔镜高位骶韧带联合圆韧带悬吊术治疗POP-Q分期Ⅱ~Ⅲ期子宫脱垂患者的临床疗效。方法回顾性分析青岛市市立医院2011年8月至2015年8月因POP-Q分期Ⅱ~Ⅲ期子宫脱垂行腹腔镜子宫全切+高位骶韧带、圆韧带悬吊术的患者共76例为研究组,同期行腹腔镜子宫全切+高位骶韧带悬吊术的患者41例为对照组,采用POP-Q评分、视觉模拟满意度(VAS)、盆底障碍影响简易问卷(PFIQ-7)和性生活质量问卷(PISQ-12)评价手术主客观满意度、生活质量及性生活质量。结果两组术后POP-Q各指示点、VAS评分比较差异无统计学意义(P0.05);术后PFIQ-7评分研究组97.05±22.89,对照组104.83±10.44,差异有统计学意义(P0.05);术后PISQ-12评分研究组39.54±3.67,对照组37.09±2.85,差异有统计学意义(P0.05)。研究组复发4例(5.26%),对照组复发8例(19.51%),差异有统计学意义(P0.05)。结论腹腔镜下高位骶韧带联合圆韧带悬吊术可有效治疗POP-Q分期Ⅱ~Ⅲ期的子宫脱垂患者,远期效果好,可明显改善患者的生活质量。     

子宫脱垂的腹腔镜手术治疗进展

子宫脱垂是一种常见的妇科疾病。子宫脱垂的病因是多因素的,包括神经肌肉功能障碍和盆底筋膜的缺陷。近年随着腹腔镜技术在妇科手术中的应用及补片材料的研发应用,使腹腔镜下治疗子宫脱垂并保留子宫成为可能。出现多种术式变化,如腹腔镜下子宫圆韧带悬吊术、子宫骶骨岬固定术、宫骶韧带缩短术等。由于腹腔镜技术具有视野开阔、创伤小、术后恢复快、住院时间短等优点,使其成为近年研究的热点。     

腹腔镜腹直肌悬吊术治疗子宫脱垂50例分析北大核心CSCD

目的探讨腹腔镜下腹直肌悬吊术治疗子宫脱垂的效果。方法 2013年11月至2015年5月抚顺矿务局总医院对50例子宫脱垂患者行腹腔镜下腹直肌悬吊术。记录患者手术时间、术中出血量、住院时间,术后3、6、9、12个月进行随访,观察患者术后复发率、恢复正常时间。结果 50例患者完成经腹腔镜子宫脱垂腹直肌悬吊术,手术时间(25±5)min,出血量(15±5)mL,平均住院天数(5±1)d,术后3、6、9、12个月随访,性生活正常,1例患者术后发生轻度阴道前壁膨出,5例患者术后有腹壁牵拉不适感,但经过一段时间适应后不适感均消失。3例患者术后频有尿意感,3个月后症状自然消失,术后无一例复发。结论腹腔镜下子宫脱垂腹直肌悬吊手术安全易行、近期效果确切、创伤小,患者经济负担小,可能成为治疗子宫脱垂新的治疗方法。     

腹腔镜髂耻韧带悬吊术及其疗效的对照研究

目的:比较腹腔镜髂耻韧带悬吊术与腹腔镜骶骨固定术治疗盆腔脏器脱垂(POP)及纠正轻中度压力性尿失禁(SUI)的疗效.方法:选取2018年6月至2021年6月山东省淄博市中心医院收治的子宫脱垂患者,其中126例行腹腔镜下髂耻韧带悬吊术,42例行腹腔镜骶骨固定术.通过手术前后POP评价体系各指示点、盆底四维超声测量值的变化...     

73例腹腔镜子宫/阴道骶骨固定术治疗盆腔器官脱垂的疗效观察

目的:探讨腹腔镜子宫/阴道骶骨固定术对盆腔器官脱垂(POP)患者的临床疗效。方法:分析2012年11月至2017年8月我院经POP定量分度法(POP-Q)证实为阴道穹窿脱垂Ⅱ期以上、中盆腔缺陷为主的POP初治患者(≥Ⅲ期)以及部分POP手术后复发患者73例,分别行腹腔镜子宫/阴道骶骨固定术。手术前后分别依据POP-Q、国际尿失禁调查问卷(ICIQ-SF)、盆底功能障碍疾病相关问卷-简要版(PFDI-20)、盆底疾病生活影响问卷-简易版7(PFIQ-7)、盆底器官脱垂/尿失禁对性功能影响的调查问卷(PISQ-12)、尿失禁生活质量影响问卷(I-QOL)、泌尿生殖道疾病相关问卷-6(UDI-6)、尿失禁影响程度相关问卷-7(IIQ-7)分别评价解剖和功能疗效。结果:73例患者均成功完成手术,4例行腹腔镜下子宫骶骨固定术,5例行经阴道全子宫切除术+腹腔镜下骶骨固定术,64例行腹腔镜下全子宫切除术+骶骨固定术。POP-Q分期Aa、Ba、C、Ap、Bp各指示点解剖位置均数由术前(2.12±1.27)cm、(3.66±2.92)cm、(2.65±2.68)cm、(0.79±1.91)cm、(1.56±3.04)cm分别恢复为术后(-2.72±0.21)cm、(-2.74±0.19)cm、(-6.60±2.88)cm、(-2.50±0.69)cm、(-2.37±1.08)cm。PFIQ-7、PFDI-20评分由术前(33.71±11.12)、(49.69±10.02)分恢复为(2.01±6.11)、(3.03±10.02)分,I-QOL评分由术前(79.40±27.64)分提高到(106.96±13.02)分(P0.001)。结论:腹腔镜子宫/阴道骶骨固定术可恢复盆腔脱垂患者POP-Q正常解剖结构,显著提高患者的生活质量及性生活质量,客观满意度高,治疗效果满意。     

腹腔镜下腹膜外子宫悬吊术加骶韧带缩短术治疗子宫脱垂的疗效观察

目的:探讨腹腔镜下腹膜外子宫悬吊术加子宫骶韧带缩短术治疗子宫脱垂的疗效。方法:选取2009年9月至2013年10月在我院实施腹腔镜下腹膜外子宫悬吊术加骶韧带缩短术的60例子宫脱垂患者,评价其手术疗效,并采用PISQ-12评估患者的性生活质量。结果:60例患者腹腔镜子宫悬吊手术时间14~22min,平均(18.4±17.3)min;骶韧带缩短时间为10~19min,平均(12.4±9.3)min;术中出血量10~25ml,平均(11.2±12.1)ml。术中、术后均无并发症发生。随访10~52个月,平均(28.46±9.54)个月。除1例患者12个月后失访,其余59例均未见复发,客观治愈率为100%。与术前比较,术后3、6、12个月的POP-Q各指示点Aa、Ba、C、GH、PB、Ap、Bp、D的位置变化显著,差异均有统计学意义(P0.001)。60例患者的术前PISQ-12总分为(24±6)分。60例患者中,56例术后3个月后有规律性生活,PISQ-12总分为(37±7)分,术后性生活质量较术前明显改善(P0.05)。结论:腹腔镜下腹膜外子宫悬吊术加子宫骶韧带缩短术治疗子宫脱垂创伤小,恢复快,复发率低,不影响性生活质量,值得临床推广应用。     

Laparoscopic uterosacral ligaments plication for the treatment of uterine prolapse

Objective To present preliminary results of a simple, minimally interventional, uterus-sparing procedure for uterine prolapse repair. Methods This prospective study was undertaken on women with symptomatic uterine prolapse ≥2nd stage, who declined hysterectomy at the time of prolapse surgery. A 10 mm laparoscope and three 5 mm ancillary trocars were used to perform the procedure. The uterosacral ligament was invested with a nonabsorbable suture. A total of three helical type sutures were placed full-thickness in the uterosacral ligament, beginning in the distal third of the ligament. The ends of the suture were tied with an extra-corporeal knot-tying technique on each side, thus shortening the ligaments. Finally, the round ligaments were plicated to restore the uterus to its correct anatomic position. No additional surgical procedure was performed concomitantly. Results Ten patients underwent laparoscopic uterosacral ligaments plication for the treatment of symptomatic uterine prolapse. The median (range) patients age was 45.5 years (36–66). Five (50%) patients were premenopausal and 3 (60%) had not completed their family. The median operating time was 22.5 min (20–45). No intraoperative complications occurred. The median follow-up time was 21 months (range 15–33). The median postoperative difference in POP-Q point C was −3 cm (range 0 to −5). Eight (80%) patients were objectively cured at the last follow-up evaluation and all of them reported a complete resolution of their symptoms. Two women had prolapse recurrence and underwent vaginal hysterectomy 7 and 24 months after primary surgery, respectively. Conclusion Laparoscopic uterosacral ligaments plication is a minimally invasive and straightforward simple procedure that appears to be a safe and effective treatment option for women with uterovaginal prolapse who desire uterine preservation.     

A review of laparoscopic uterine suspension procedures for uterine preservation

PURPOSE OF REVIEW: The most appropriate surgical approach for uterine preservation still remains the subject of ongoing controversy. Uterine suspension procedures can be performed abdominally, vaginally, or laparoscopically. This article focuses on the three different laparoscopic approaches of uterine suspension for uterine preservation: suspension to the round ligaments; suspension to the uterosacral ligaments; and suspension to the anterior ligament of the sacral promontory. This article reviews the published studies in the literature, analyzes the results, discusses the differences, and compares the different laparoscopic techniques. RECENT FINDINGS: A review of the literature reveals a paucity of research studies and publications on laparoscopic uterine suspension procedures. All the published studies are small, retrospective case series or case studies. Laparoscopic ventrosuspension using the round ligaments for uterine prolapse has a reported success rate of less than 50%. The ventrosuspension procedure has a very limited role and should not be employed. In comparison, laparoscopic uterine suspension procedures have a reported success rate ranging between 81 and 100%. The newest surgical technique is the laparoscopic sacral colpohysteropexy and there is only one reported case series on this procedure. The reported success rate for the sacral colpohysteropexy is 100%. SUMMARY: The first surgical option for uterine preservation is uterine suspension to the uterosacral ligaments. If the uterosacral ligaments cannot be identified or the uterosacral ligaments are weak and unusable, then laparoscopic sacral colpohysteropexy is a reliable second option. Uterine suspension to the round ligaments has an unacceptably high failure rate and is not an effective, durable alternative.     

经阴道子宫骶骨韧带高位悬吊术治疗子宫脱垂的临床探讨

目的探讨经阴道子宫骶骨韧带高位悬吊术（HUS）治疗子宫脱垂的解剖生理基础、适应证、手术技巧、输尿管损伤的预防及临床近、中期疗效。方法2003年6月至2007年9月，采用经阴道HUS悬吊阴道穹隆、重建耻骨宫颈筋膜及直肠阴道筋膜，治疗中、重度子宫脱垂50例。患者平均年龄60．1岁，术后平均随访时间24个月（4～51个月）。同时采用盆腔器官脱垂定量分度（POP-Q）法对子宫脱垂程度及手术后结果进行评价，以术后C点值≤POP-QⅠ度计算成功率。结果术中50例中、重度子宫脱垂患者的宫骶韧带均可在后腹膜坐骨棘内后侧、经长组织钳钳夹牵拉、清楚触及和辨认，并均成功对阴道穹隆进行了悬吊和筋膜重建。术中应根据对输尿管解剖部位和相邻关系的准确认识、术中触摸、掌握缝合进针深度及方向、膀胱镜检查并确认输尿管开口位置等方法避免输尿管损伤。50例中，无一例输尿管损伤。术后平均随访时间24个月，POP-Q法C点值由术前1．5cm降为术后的-7．5cm；主、客观成功率均达100％。结论经阴道HUS悬吊并重建阴道穹隆、耻骨宫颈筋膜、直肠阴道筋膜是利用自身组织作为悬吊点治疗子宫脱垂，符合恢复解剖生理、保留功能及微创原则，主、客观成功率高。     

Sexual functioning after vaginal hysterectomy or transvaginal sacrospinous uterine suspension for uterine prolapse: a comparison

OBJECTIVE: To examine changes in sexuality after total vaginal hysterectomy (TVH) or transvaginal sacrospinous uterine suspension (SSUS)for uterine prolapse. STUDY DESIGN: One hundred fifty-eight women with moderate to severe uterine prolapse undergoing TVH (78) or SSUS (80) were included in a prospective study from January 2001 to June 2002. All women were <50 years old and sexually active within the last 6 months before surgical intervention. None had major medical disorders. Sexual functioning before and 6 months after surgery was examined via a face-to-face questionnaire. Sexual interest, sexual satisfaction, frequency of sexual intercourse and frequency of orgasm were measured using an analogue scale. RESULTS: Of women undergoing TVH, 5.1% had decreased sexual interest, and 21% had less frequent orgasms postoperatively. For women undergoing SSUS, 13% had decreased sexual interest, and 20% had less frequent orgasms postoperatively. Frequency of orgasm was the only parameter that changed significantly after surgery in the 2 groups. All women with less frequent orgasms said that they were afraid of wound disruption or disease recurrence and so refrained from vigorous or exciting sexual intercourse. About four-fifths of the women in both groups accepted or were satisfied with their sexuality after surgery. For women undergoing TVH, 2.6% had increased frequency of orgasm, and 5% had better overall sexual satisfaction postoperatively. For women undergoing SSUS, 10% had increased sexual satisfaction postoperatively. There was a 2.5% and 2.6% increase in postoperative sexual interest in the SSUS and TVH groups, respectively. The sexual functioning scores were not different before or after surgical intervention in either group. CONCLUSION: There is a decrease in thefrequency of orgasm after both TVH and SSUS. However, there is no significant difference in postoperative sexual functioning between women with and without preservation of the uterus in correcting uterine prolapse.     

Laparoscopic sacrocervicopexy for the treatment of uterine prolapse: a retrospective case series report

STUDY OBJECTIVE: To evaluate apical support in patients desiring uterine preservation with pelvic organ prolapse who underwent laparoscopic sacrocervicopexy. DESIGN: Retrospective case series report (Canadian Task Force classification III). SETTING: Academic community teaching hospital. PATIENTS: Forty consecutive women who underwent laparoscopic sacrocervicopexy. INTERVENTIONS: Synthetic mesh was used to attach the distal uterosacral ligaments and posterior endopelvic fascia to the anterior longitudinal ligament of the sacral promontory. MEASUREMENTS AND MAIN RESULTS: Pelvic organ prolapse quantification system measurements were used and apical support was evaluated using point C. Mean C was -1.13 (+9 to -4) preoperatively, -5.28 (-3 to -13) at 6 weeks postoperatively, -5.26 (-3 to -8) at 6 months postoperatively, and -4.84 (-3 to -7) at 1 year postoperatively. CONCLUSION: Laparoscopic sacrocervicopexy is an effective option for women with pelvic organ prolapse who desire uterine preservation.     

Laparoscopic uterine sling suspension: a new technique of uterine suspension in women desiring surgical management of uterine prolapse with uterine conservation

The surgical management of uterine prolapse in women who wish to retain their uterus remains a challenge. Several techniques have been reported using open abdominal, laparoscopic and vaginal approaches. The laparoscopic approach offers both excellent intraoperative visualisation of supportive and adjacent structures and quick postoperative recovery. Currently, laparoscopic suspension of the uterus to the round ligaments, uterosacral ligaments, suture and synthetic mesh suspension to the sacral promontory have been reported. This report describes a new surgical technique of laparoscopic uterine suspension, which has been performed successfully in eight women. Mersilene tape is used to suspend the uterus to the sacral promontory bilaterally and to recreate new uterosacral ligaments.     

Laparoscopic hysterectomy with retroperitoneal uterine artery sealing using LigaSure™: Gazi hospital experience

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of laparoscopic hysterectomy by retroperitoneal sealing of the uterine arteries with LigaSure. METHODS: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure was performed by four-puncture laparoscopy in 50 women with various indications for hysterectomy. The mean operation time, amount of intraoperative bleeding, drop in hemoglobin concentration, weight of removed uterus, major and minor per-post operative complications, and the rate of conversion to classical abdominal approach were analyzed prospectively. RESULTS: The mean operation time was 85 min (range 60-125 min). The mean weight of removed uterus was 180 g (range 60-650 g). There was one major complication; one patient had cystotomy due to difficulty in dissecting severe adhesions because of two previous cesarean sections that were repaired laparoscopically. Only one patient converted to laparotomy because of severe bowel adhesions due to rectovaginal endometriosis. All patients were discharged on the first postoperative day. No minor complications occurred. Hemoglobin decreased a mean of 0.4 g/dl (range 0.2-1.4 g/dl) by postoperative day 1. CONCLUSION: Laparoscopic hysterectomy by retroperitoneal uterine artery sealing with LigaSure is an effective, safe, and fast procedure with less intra operative bleeding, short operation time and hospital stay.     

Laparoscopic sacral colpopexy with Gynemesh as graft material--experience and results

STUDY OBJECTIVE: To evaluate the safety and efficacy of Prolene (Ethicon, Inc., Johnson and Johnson, Somerville, NJ) graft for sacral colpopexy and ease of use laparoscopically. DESIGN: Retrospective analysis (Canadian Task Force classification II-1). SETTING: Academic university hospital. PATIENTS: Seventy-four patients with recurrent prolapse of the apex or severe uterine prolapse (stage II-IV). INTERVENTIONS: Seventy-four patients with recurrent prolapse of the apex or severe uterine prolapse (stage II-IV) underwent laparoscopic sacral colpopexy or cervicopexy with Gynemesh (Ethicon, Inc.) used as the graft material. MEASUREMENTS AND MAIN RESULTS: Seventy-four patients, from March 2003 through March 2006, underwent a sacropexy. Fifty-one patients had recurrent apical prolapse, 22 patients had uterovaginal prolapse stage III or IV, and 1 patient had uterovaginal prolapse stage II and insisted on retaining the uterus. Fifty-two patients also had a concurrent sling procedure performed for incontinence. Intraoperative and postoperative complications included 1 middle sacral bleed managed by suturing in the middle sacral region and 1 postoperative cervical abscess requiring reoperation and removal of the graft at 10 days. All patients were evaluated at 2 weeks and 6 weeks after surgery, and pelvic examination was performed. They were then followed up biannually. Median age was 63 years (range 48-76 years), and median body mass index was 35 (range 24-41). Laparoscopic sacral colpopexy or cervico or uteropexy was performed successfully in 72 patients. Median blood loss was less than 25 mL (range 25-150 mL), and the median hospital stay was 1 day (range 1-2 days). One surgery was terminated because of dense rectosigmoid adhesions to the cuff requiring a laparotomy and partial sigmoid resection because of redundancy and postdissection trauma to the sigmoid. Another procedure was completed as a Prolift (Johnson and Johnson) procedure because of finding of a prior Mersilene (Phillips Sumika Polypropylene Co., Houston, TX) mesh that was densely adherent to the pelvic contents. Seventy patients are extremely happy and satisfied with the surgery. Postoperative recovery has been uneventful, and subjective and objective cure is 97% and 100%, respectively. One patient with sacrouteropexy still has stage I prolapse of her cervix, but it feels well supported. There have been no cases of colpopexy graft exposure or recurrence with a median follow-up of 24 months (range 9-36 months). The patient with cervical abscess and graft removal has also healed with no recurrance of her prolapse. CONCLUSIONS: Laparoscopic sacral colpopexy or cervicopexy is a safe and effective procedure with excellent results. Gynemesh (Ethicon, Inc.), a wide-pore polypropelene mesh seems to be an excellent graft material with low risk for graft infection (1.4%) or erosion.     

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.