**4. Management options**

The management options of recurrent pelvic organ prolapse is almost always surgical. It is to be realized that surgical options are the first choice as they provide a long-term relief. Surgical measures should always be accompanied by pelvic muscle strengthening exercises in the postoperative period for best outcome.

The surgical procedure must be case based. If the initial repair was vaginal hysterectomy with pelvic floor repair the subsequent repair can be sacrospinous colpopexy or sacrospinous fixation. If the initial repair was sacrohysteropexy the recurrent prolapse can be managed by vaginal hysterectomy, anterior colporrhaphy and posterior colpoperineorrhaphy along with McCall's culdoplasty.


**Table 1.** Corrective surgery for vaginal vault prolapse.

The reconstructive surgical procedures for the anterior and posterior vaginal vault prolapse are listed in **Table 1**. The anterior vaginal Wall repairs include anterior colporrhaphy and site-specific repair. The posterior vaginal wall repair procedures include posterior colporrhaphy, site-specific repair, perineorrhaphy, McCall's culdoplasty and Moskowitz procedure. The procedures for vault prolapse following hysterectomy include sacrospinous colpopexy, uterosacral ligament (USLS) suspension via abdominal or vaginal route, ileococcygeal fascia suspension and abdominal sacrocolpopexy [21].
