Pelvic prolapse has a myriad of clinical manifestations ranging from urethral incontinence to total vault prolapse. The evaluation and treatment of these conditions is facilitated by dividing them into three anatomic regions. Anterior vaginal wall prolapse is the most common type and includes simple urethral hypermobility as well as severe cystocele. Surgical treatment includes the modified anterior vaginal wall sling, six-corner bladder neck suspension, and formal cystocele repair. Posterior vaginal wall prolapse, manifested by rectocele and perineal relaxation, is corrected by plication of the prerectal and pararectal fascia, reconstruction of the levator hiatus, and repair of the perineal body. Vault prolapse includes enterocele, uterine prolapse, and generalized vault prolapse. The choice of treatment depends on the presence of anterior vaginal wall prolapse, the degree of vault prolapse, and the patient's desire to remain sexually active. It is important to remember that urethral incontinence is only one manifestation of pelvic prolapse, and must be treated in conjunction with other prolapse to avoid recurrence or poor results.
