I have read with great interest the research of Maher et al on a total vaginal mesh for vaginal vault prolapse.

I think that the research is very important for the purpose of having evidence-based data to offer the patient regarding the best procedure for vault prolapse repair. The author’s claim that the laparoscopic approach has higher objective success rate, based on POP-Q measurement, is questionable. The difference between the laparoscopic approach and the vaginal mesh approach was 1.33 cm for point C, 0.53 cm for point Ba, and 0.68 cm for point Bp, in favor of the laparoscopic arm. These differences, even though they have statistical significance, have no clinical significance. They are all stage 1 POP-Q, closer to stage 0 than stage 2.

We know that these measures are not absolute because they depend on the Valsalva effort and vaginal elasticity that cannot be standardized and differ among patients and the same patient during different examinations. Therefore, the conclusion that the laparoscopic sacral colpopexy has a higher objective success rate is not convincing.