The classic procedures for uterine prolapse are the mannoplasty, the pubic hysterectomy and the vaginal closure. Of these, the pubic hysterectomy is the most widely used. The traditional post-hysterectomy vaginal vault bulge is a difficult problem in clinical practice. The incidence of vaginal vault bulge after hysterectomy ranges from 2% to 45%, especially in patients with severe uterine prolapse who have a higher incidence of vaginal vault bulge after hysterectomy alone. With the increased use of hysterectomy and the increase in human life expectancy, the treatment and prevention of vaginal vault bulge has received increasing attention, which in turn has led to new concepts of pelvic floor anatomy, emphasizing the need for pelvic floor reconstruction. The new internationally recognized effective procedures are as follows and are described below. 1.Uterine or vaginal vault sacral suspension The classic uterosacral suspension is performed with a mesh with both ends sutured to the vaginal vault and the tough fibrous tissue in front of the sacral S2S4, i.e. the anterior longitudinal ligament, in the case of double uterosacral ligaments or hysterectomy. Uterosacral suspension lifts the uterus to its normal anatomical position so that the cervix and vaginal tip are elevated on the pelvic floor platform, maintaining normal vaginal axis and length, and normal pelvic floor anatomy, and postoperative sexual satisfaction reaches 88.8%. It is suitable for those who have no lesions on the uterine body and normal cervical cytology, especially for unmarried and infertile people with fertility requirements. The cure rate is about 93% for open surgery and about 80% for laparoscopy. The recurrence rate is about 5%. Complications are: bleeding: 3%; sacral osteomyelitis (reported in some cases 5 years after surgery); mesh erosion: 3.3%. 2.Sacrospinous ligament fixation For uterine prolapse with main and sacral ligament laxity. After the pubic hysterectomy, the rectovaginal space is reached through the perineal or posterior vaginal wall incision, and the sciatic spine and sacrospinous ligament can be reached by crossing the rectal column. Suturing the vaginal stump to this ligament preserves the vaginal function and maintains the horizontal axial position of the vagina on the levator plate with long-lasting and reliable results. Unilateral SSLF is usually sufficient for this purpose, but bilateral SSLF is also possible if the apical vaginal tissue is wide enough; the cure rate is reported to be about 90% in the literature. Complications are: bleeding, lumbosacral pain, leg pain, and new postoperative urinary incontinence. 3.Skeletal caudal fascia fixation Similar to SSLF, only the fixation point is located on the skeletal caudal fascia in front of the sciatic spine. Some scholars believe that the fixation point here is more accessible and less likely to damage blood vessels and nerves, but the postoperative depth of the vagina may be slightly shorter than that of SSLF. The healing rate and complications are similar to those of SSLF. 4.Total pelvic floor reconstruction surgery The entire pelvic cavity is reconstructed from the anterior, middle and posterior regions of the pelvic floor to fully correct pelvic floor defects. Trimmed non-absorbable, light, porous, single-strand woven polypropylene mesh system, which includes the construction of anterior, posterior and combined parts, this surgical procedure is safe, effective, time-saving and minimally invasive. With more than five years of practice, the cure rate is about 90-95%, which is the reconstruction surgery with the highest cure rate at present. However, complications include mesh erosion, exposure and protrusion problems, postoperative urinary retention, urinary tract infection, bleeding, peripheral organ damage, new postoperative incontinence no, and sexual function effects are of concern. Various modified vaginal mesh pelvic floor reconstruction procedures with similar principles have also shown good clinical results. 5.High sacral ligament suspension High uterosacral ligament suspension, also known as McCall Procedure or McCall’s sculdoplasty, is performed transvaginally. after hysterectomy, the uterosacral ligament is lifted by clamping it with Allis forceps from the level of the high flat sciatic spine, and the uterosacral ligament is sutured and knotted with 2-3 stitches of non-absorbable suture to shorten its ligament length. Mayo Hospital in the United States has improved this method, in addition to suturing the shortened uterosacral ligament, they then suspend the vaginal tip over the shortened sacral ligament, hence the name vaginal sacral ligament suspension, which requires more auxiliary instruments to help the suturing be easy to perform. The cure rate of this procedure is around 80%, and Wu et al. described laparoscopic suspension of the high uterosacral ligament in 1997, with a cure rate of around 80%. Complications are mainly ureteral injuries. Posterior transvaginal suspension was created and reported by Australian surgeon Petros in 1997 based on Integraltheory (PosteriorIntra-viginalslingplasty,PosteriorIVS). This new procedure treats vaginal vault prolapse. It is 90% effective in treating vaginal vault prolapse and is also effective in preventing vaginal vault bulge after severe prolapse hysterectomy. However, the complications of the multi-strand braided material of the sling are now used sparingly. In conclusion. There are many surgical treatment options, which can be divided into transvaginal surgery, transabdominal surgery and laparoscopic route according to their surgical route. No single procedure can be adapted to all patients and should be considered based on a comprehensive analysis of their age order, requirements for preservation of sexual function, degree of vaginal wall bulge, cervical length and degree and lesions, presence of uterine and adnexal diseases, comorbidities and previous treatment.