High Midline Levator Myorrhaphy for Vault Prolapse Repair

  • Yuefeng (Rose) Wu
  • Philippe E. ZimmernEmail author


High midline levator myorrhaphy (HMLM), first described in 1988, is a vaginal surgery for vault prolapse (VP) that does not rely on mesh interposition, avoids the inherent difficulties associated with sacrospinous ligament fixation (SSLF) involving nearby vascular and neural structures, and is well-suited for middle-aged to older women [1]. Unlike the SSLF [2, 3], HMLM keeps the vagina midline, and unlike the uterosacral ligament (USL) fixation [4], HMLM can be done many years after hysterectomy when the uterosacral ligaments are no longer readily identifiable. Since its original report, there have been few published series on surgical outcomes [1, 5], none of which included long-term data. We review the technique of this procedure in detail and provide an update on our long-term experience with this technique.


Vault prolapse Recurrence Long term follow-up Surgical repair 

Supplementary material

Video 11.1

(AVI 159461 kb)


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.UrologyUT SouthwesternDallasUSA
  2. 2.Department of UrologyUT Southwestern Medical CenterDallasUSA

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