Vaginal vault prolapse typically occurs as a result of tearing of the utero-sacral ligaments off of the vaginal cuff in a woman who has previously undergone a hysterectomy. In non-hysterectomized women, stretching of the utero-sacral ligaments due to inherent connective tissue weakness can result in vaginal vault prolapse. Women with vaginal prolapse may present with various forms of voiding dysfunction. These include urinary retention, urgency and frequency and urinary stress incontinence. When evaluating bladder function in a woman with vault prolapse it is key to evaluate her bladder function with a prolapse reduced. A woman who leaks during her pelvic examination with a vault suspended should be strongly suspected of having intrinsic sphincter deficiency which needs to be addressed individually at the time of her prolapse correction surgery. Urodynamic testing pre-operative to evaluate urethral sphincter function is fundamental. 

Figure1: Vaginal prolapse in hysterectomized woman