ABSTRACT

Reconstructive surgery for pelvic organ prolapse remains a challenge even for the most seasoned pelvic surgeon, requiring a detailed knowledge of pelvic anatomy and the supportive structures of the uterus and vagina. Numerous approaches and techniques, each with its own distinct advantages and disadvantages, exist for the repair of each vaginal compartment. Ultimately, regardless of approach, there remains a set of core goals of pelvic reconstruction which include the restoration of normal vaginal depth, caliber, and axis; prevention of further pelvic organ prolapse; and restoration and maintenance of normal bladder, bowel, and sexual function. This chapter reviews the applied anatomy and common reconstructive techniques employed to repair each vaginal compartment in order to achieve these surgical goals.