Many controversies surround pelvic prolapse repair techniques. Traditional repair of the anterior and posterior vaginal wall defects are associated with a high risk of recurrent prolapse. Surgical advancement were developed, viewing vaginal wall repair as being equivalent to hernia repair. To strengthen repairs the addition mesh was incorporated to lessen recurrence. My preferred product is Xenform, a biologic collagen product which provides a soft, uniform matrix which aids in the regenerative process. When the Xenform graft is hydrated it can then be cut and shaped to match the vaginal compartment being repaired. The graft then may be sutured to thesacrospinous ligament, providing suspension of the pelvic floor. Over time the mesh is absorbed by the body, replaced with the patient's own collagen, providing a natural, soft feel to the repair.

When the apex (top) of the vaginal is the primary site of prolapse, rather then the bladder or the rectum, repair is focused on the support structures of the cervix or top of the vagina. This repair is a laparoscopic surgery, shortening the ligaments attaching to the cervix or vagina (uterosacral ligament). The apical prolapse may be also be repaired using a permanent mesh attaching the top of the vagina to the sacrum through a long Y shaped mesh passed through the pelvis and secured to the spine (sacrocolpopexy). Often problems associated with pelvic floor prolapse require both repair of the anterior/posterior vagina and the vagina apex.