Post-Hysterectomy Vaginal Vault Prolapse: Current Perspectives and Decision-Making Considerations for Surgical Treatment

Background and Objectives: Following the removal of the uterus, due to prolapse or other indications, disruption of the apical support structures may result in descent of the vaginal apex. As the condition progresses, the cystocele, rectocele, and/or enterocele are formed, finally creating a complex vaginal eversion that generally requires surgical multi-compartmental repair. This review aimed to provide a comprehensive overview of cur-rent surgical modalities for post-hysterectomy vaginal vault prolapse, which could sup-port personalized treatment. Materials and Methods: MEDLINE, Scopus and Google Scholar databases were searched to retrieve freely available manuscripts published in English language since the year 2000. Results: Surgical correction remains the basis of management for symptomatic post-hysterectomy vaginal vault prolapse. The primary objective of treatment is restoration of robust apical support, normalization of vaginal axis, preservation of sexual and urinary function along with minimization of operative complications and recurrence. Several reconstructive approaches have been established as safe and comparatively reliable. They are classified into native tissue vaginal repairs (sacrospinous ligament fixation, uterosacral ligament suspension), abdominal or minimally invasive sacro-colpopexy, mesh-augmented techniques, and obliterative procedures. No single surgical approach appears universally superior across anatomical, functional, and safety outcomes, and procedure selection should therefore be individualized according to patient characteristics, treatment priorities, and surgeon expertise. Consequently, procedure selection should be individualized according to patient characteristics and surgeon expertise. Conclusions: Post-hysterectomy vaginal vault prolapse remains a complex and clinically significant condition. Current evidence supports the central importance of apical suspension during all hysterectomies. Optimal treatment outcomes are achieved through patient-centered decision-making that balances durability, safety, functional recovery, and individual expectations.