To optimize the choice of a surgical treatment option, the authors examined and operated on 754 patients with the complicated forms of internal genital descent and prolapse (IGDP): transvaginal implantation of a synthetic mesh (Prolift technology) was performed in 365 patients with cysto- and rectocele, TVT-O sling technology was used in 389 patients with stress incontinence. The examination included clinical, laboratory, ultrasound studies and questioning. Ultrasound diagnosis of latent fascial defects was established to be a real way to choose an adequate method for the treatment and prevention of IGDP recurrences. An individual surgical program was made up for all 754 patients, by taking into account age, underlying, concomitant gynecological, extragenital pathology, the presence and degree of connective tissue dysplasia and pelvic fascial defect. The efficiency of Prolift and TVT-O sling operations was 98.4 and 96.7%, respectively. The preoperative clinical and ultrasound diagnosis of pelvic fascial defects was shown to play a decisive role in the outcome of surgical treatment in patients with the complicated forms of IGDP as it permits the choice of an optimal surgical procedure.