ABSTRACT
Prolapse of the vaginal apex may occur with the uterus in situ or following a previous hysterectomy. The vaginal apex is normally supported by the uterosacral–cardinal ligament complex and the levator ani musculature, nominated by delancey [1] as level 1 support. This defect in most cases occurs secondary to weakness in the muscular levator ani complex, which can occur as a result of obstetric injury with muscular tearing or denervation, aging, or even congenital defects such as spina bifida or bladder extrophy. Apical loss of support secondary to muscular injury may be unilateral or bilateral resulting in apical prolapse. This often occurs in the presence of anterior and/or posterior compartment prolapse. Identifying the extent of apical prolapse during the clinical examination and then addressing the apex during prolapse surgery is crucial to providing a durable repair.
