Given that surgical reconstruction for apical vaginal prolapse demands proper training and involve hazards to the pelvic organs, is a challenging issue for pelvic floor surgeons. Patients suffering advance uterine prolapse presents with a variety of debilitating symptoms and significantly impaired quality of life. Proper understanding the herniation nature of the problem and precise pelvic floor anatomy details are essential for being able to design and perform a safe, curative and durable pelvic floor reconstruction. Patients having post hysterectomy vaginal vault prolapse are in a worth situation, as the anatomy is frequently distorted, the supportive tissues are weakened, and the vagina is often shortened. All these makes the efficient reconstruction even more difficult; the following summary was written to shed light on this particular field.