anatomy and application of anterior perineal suspension axis in treatment of pelvic organ prolapse

Background & objective: the anterior perineal suspension axis (apsa), comprising the pubocervical fascia and the cervico-uterine-sacral complex, maintains urogenitalsupport. weakening or injury leads to pelvic organ prolapse (pop). restoring this axis may re-establish physiological support. this review aimed to summarize apsa anatomy and physiology, define the supportive roles of its components, and evaluate the potential of laparoscopic of the apsa to the bilateral pectineal ligaments (lapspl) for pop.materials & methods: this structured narrative review searched pubmed, scopus, sciencedirect, and google scholar (1957-2025). eligible studies addressed pelvic anatomy/physiology, support mechanisms, or pop surgery, discussing apsa/ppsa, the pectineal ligament, the sacral promontory, or related conditions (cystocele, uterine prolapse, anterior compartment prolapse). exclusion criteria were non-peer-reviewed items, -case reports without anatomical or physiological focus, and studies unrelated to pelvic support systems or pop surgery. two reviewers independently screened records and appraised full texts. the disagreements were resolved by consensus or a third reviewer.results: evidence identifies apsa as a principal stabilizer of the urogenital compartment. the pectineal ligament provides a robust, neurovascularly safe anchoring site aligned with the physiological uterovaginal axis. techniques not reconstructing the anterior axis may leave anterior defects uncorrected. early lapspl series reported short operating times, low blood loss, minimal complication and recurrence, with overall improvements in anterior wall support and symptoms, including in recurrent pop.conclusion: restoring apsa is anatomically and physiologically rational for pop management. lapspl appears safe and effective; larger multicenter comparative studies with longer follow-up are needed to strengthen the evidence base and refine indications.