Pelvic Organ Prolapse · Patient guide

What Surgery Is Used for Pelvic Organ Prolapse? Options Compared

The surgery used for pelvic organ prolapse depends on which organ has dropped: anterior repair for a cystocele, posterior repair for a rectocele, hysteropexy or hysterectomy with vault suspension for uterine prolapse, sacrocolpopexy or sacrospinous fixation for vault prolapse, and colpocleisis for women who no longer want vaginal intercourse. Somssi Women's Clinic in Seoul uses vaginal native-tissue repair with hysteropexy and no mesh.

Medically reviewed by Dr. Yoon Ho-joo, MD, PhD, OB/GYN specialist, Somssi Women's Clinic · Last updated October 2026

At a glance

Key facts

The essentials, based on how Somssi Women's Clinic performs this procedure or answers this question. Your plan is confirmed at consultation.

• Routes: vaginal (most common), laparoscopic or open abdominal
• Materials: your own tissue (native tissue) or synthetic mesh; transvaginal mesh for prolapse was withdrawn from the US market in 2019
• Somssi's method: vaginal native-tissue repair, hysteropexy with culdoplasty, posterior wall thickening, figure-8 pelvic floor strengthening
• Operation time at Somssi: 50 minutes to 1 hour
• Anesthesia: sedation plus long-acting local, or local alone
• Hospital stay: same-day discharge
• Not offered at Somssi: mesh implants; advanced cases may be referred to a hospital

There is no single "prolapse operation": surgeons choose from anterior repair, posterior repair, uterine suspension (hysteropexy), hysterectomy with vault suspension, sacrocolpopexy, sacrospinous fixation and colpocleisis, matching the procedure to which organ has dropped and to your goals. Understanding the menu helps you ask the right questions, whichever clinic you see.

Surgery by compartment

Front wall: cystocele (bladder)

Anterior colporrhaphy tightens the stretched tissue between the vagina and bladder. It is a vaginal operation with native tissue. Recurrence of the front wall is the most common failure in prolapse surgery, partly because the front wall carries the weight of the bladder and partly because support at the top of the vagina is often neglected. Somssi's approach avoids cutting the front wall where possible, to protect the urethra, bladder, nerves and the G-spot area, and relies on restoring the top and back supports instead.

Back wall: rectocele

Posterior colporrhaphy, often with perineorrhaphy (rebuilding the perineum between vagina and anus), repairs the wall between the vagina and rectum. This is the core of the Somssi method. The mucosa is peeled to under 1 mm rather than cut, the underlying muscle is gathered to thicken the wall by 2–3 cm, and the layers are sutured in two stages so the repair does not stretch back. A figure-8 strengthening stitch supports the pelvic floor at the opening. See posterior colporrhaphy.

Top: uterine prolapse

Two families of operation exist. Hysteropexy keeps the uterus and re-suspends it to the uterosacral ligaments (vaginally or laparoscopically), to the sacrospinous ligament, or to the sacrum with mesh (sacrohysteropexy). Vaginal hysterectomy removes the uterus; the top of the vagina must then be suspended (uterosacral or sacrospinous) to prevent vault prolapse. Somssi performs vaginal hysteropexy with native tissue, lifting the uterus about 2–4 cm and fixing it, combined with culdoplasty, closing the pouch behind the cervix. See uterine prolapse surgery and the comparison hysteropexy vs hysterectomy.

Top: enterocele and vault prolapse after hysterectomy

When small bowel pushes into the top of the vagina, or the vault drops after hysterectomy, the options are sacrocolpopexy (attaching the vault to the sacrum with a mesh strip, usually laparoscopically), sacrospinous fixation (stitching the vault to a pelvic ligament through the vagina) and uterosacral ligament suspension. Culdoplasty closes the enterocele itself.

Obliterative surgery: colpocleisis

For women with advanced prolapse who are certain they will not want vaginal intercourse, colpocleisis sews the vaginal walls together to close the canal. It is quick, highly effective and low-risk, but irreversible.

Comparison at a glance

Native tissue or mesh?

Mesh was introduced to lower recurrence rates, and abdominal sacrocolpopexy with mesh remains a well-established operation for vault prolapse. Mesh placed through the vagina, however, was linked to erosion, pain and painful intercourse, and in 2019 the US FDA ordered manufacturers to stop selling transvaginal mesh for prolapse repair. Many countries now restrict or have paused its use.

Somssi Women's Clinic, a surgical gynecology clinic in Gangnam, Seoul, founded in 2000 and led by Dr. Yoon Ho-joo, MD, PhD, does not use mesh, bands or implants for prolapse. Every repair uses the patient's own tissue. The clinic also treats women with complications from mesh or implants placed elsewhere; see vaginal mesh complication revision. Native-tissue repair carries its own trade-off: it depends on the quality of your tissue, and recurrence remains possible, which is why the clinic combines hysteropexy, posterior wall thickening and pelvic floor restoration rather than relying on one stitch line.

How Somssi decides which operation you need

The decision starts with a staged examination of each compartment, measurement of total vaginal length and wall thickness, pelvic ultrasound and an incontinence check. From that, Dr. Yoon designs a repair that typically includes hysteropexy and culdoplasty for the top, posterior wall reconstruction for the back, and pelvic floor strengthening at the opening, all in one vaginal procedure of about an hour under sedation and long-acting local anesthesia, with same-day discharge. The clinic's view is that restoring vaginal length and wall thickness, rather than only lifting the uterus, is what makes the result durable; that view is drawn from more than 25 years of pelvic surgery and from the textbook principle that a shortened vagina is more likely to prolapse again.

When a different operation is the right answer

Honesty matters here. Very advanced prolapse, prolapse after failed surgery, severe stress incontinence needing a sling, or uterine disease requiring hysterectomy may be better treated in a hospital setting, and the clinic will say so. Pelvic organ prolapse surgery is a specialty with several good tools; the skill is matching the tool to the woman.

Bottom line

Prolapse surgery is chosen by compartment: front wall, back wall, top of the vagina, or all three. Native-tissue vaginal repair with uterine preservation is the approach used at Somssi and is suitable for most women with cystocele, rectocele and uterine descent; mesh-based abdominal procedures and hysterectomy remain valid for specific situations. Ask any surgeon which compartments they will repair, how, with what material, and what happens to the top of the vagina. Then book a consultation to find out which applies to you.

Questions patients ask

Frequently asked questions

Short, honest answers. For anything personal, a consultation is the right place to ask.

See the full FAQ →

What is the most common surgery for prolapse?

Vaginal native-tissue repair, meaning anterior and/or posterior colporrhaphy with some form of apical support, is the most frequently performed prolapse operation worldwide. At Somssi, the most common combination is posterior wall reconstruction with hysteropexy and pelvic floor strengthening in a single vaginal operation.

Is mesh still used for prolapse surgery?

Mesh placed through the abdomen for sacrocolpopexy is still widely used and considered safe in experienced hands. Mesh placed through the vagina for prolapse was ordered off the US market by the FDA in 2019 because of erosion and pain complications. Somssi does not use mesh of any kind and offers revision for mesh complications.

Can prolapse surgery be done without removing the uterus?

Yes. Hysteropexy re-suspends the uterus instead of removing it and is now recognized by ACOG and IUGA as a reasonable option for women without uterine disease. It is the standard approach at Somssi.

What is the least invasive prolapse surgery?

Vaginal native-tissue repair under local anesthesia and sedation involves no abdominal incision and allows same-day discharge, making it the least invasive reconstructive option. Colpocleisis is even simpler but closes the vagina, so it suits only women who have ruled out future intercourse.

Can all compartments be repaired at once?

Usually yes, and it is generally better to do so, because repairing one wall while leaving another weak invites the untreated area to drop later. At Somssi, top, back wall and pelvic floor are typically addressed in one procedure of about an hour.

How do I know which operation a clinic is offering me?

Ask four questions: which compartments will be repaired, by what route, with what material, and how the top of the vagina will be supported. A clear answer to all four tells you the surgeon has a plan for your anatomy rather than a one-size approach.

Keep reading

Related treatments and guides

• Pelvic Organ Prolapse Repair — the clinic's main treatment page
• Pelvic Reconstructive Surgery — rebuilding several compartments in one operation
• Uterine Prolapse Surgery — hysteropexy with culdoplasty explained
• What Are the Different Types of Pelvic Organ Prolapse? — match the operation to the compartment
• Hysteropexy vs Hysterectomy for Uterine Prolapse: Which Is Better? — the apical decision in depth
• Vaginal Mesh Complication Revision — when a previous mesh operation has caused problems
• Posterior Colporrhaphy — the back-wall repair at the heart of the Somssi method

Sources and medical review

• US Food and Drug Administration (FDA) — 2019 safety communication and order on surgical mesh for transvaginal repair of pelvic organ prolapse
• American College of Obstetricians and Gynecologists (ACOG) — guidance on surgical treatment of pelvic organ prolapse
• International Urogynecological Association (IUGA) — patient information on prolapse operations
• Te Linde's Operative Gynecology — anterior and posterior colporrhaphy, uterine suspension and vault suspension techniques

Next step

A consultation first. A decision only when you are ready.

Tell us what you are experiencing and what you hope to change. Dr. Yoon examines, measures and explains the options, including when no surgery is the right answer. International patients can start with an online consultation before travelling to Seoul.