Comparison of multisite native tissue repair with anterior colporrhaphy for anterior vaginal prolapse: midterm outcomes from a retrospective cohort study

Anterior vaginal wall prolapse is the most prevalent type of pelvic organ prolapse and frequently results in recurrence after traditional native tissue repair. This study aimed to compare the anatomical and subjective outcomes of an alternative multisite native tissue repair technique with standard anterior colporrhaphy. In this retrospective cohort study, 141 women with symptomatic anterior compartment prolapse beyond the hymen (Ba > 0) underwent multisite repair (n = 66) or standard anterior colporrhaphy (n = 75) between March 2021 and September 2024. The alternative repair technique combines midline plication with transverse repair and bilateral iliococcygeal fixation. The primary outcomes included anatomical success (Ba < 0) and subjective success (PGI-I ≤ 2) after a minimum follow-up of 12 months. The secondary outcomes included quality-of-life measures (UDI-6, IIQ-7, and P-QoL), postoperative de novo lower urinary tract symptoms, and complications. The median follow-up duration was 24 months in both groups. Multisite repair achieved higher anatomical (88% vs. 44%, p= .001) and subjective success rates (97% vs. 68%, p= .001) than standard anterior colporrhaphy. The study group also showed significantly better postoperative POP-Q scores and total vaginal length. Both groups experienced significant improvements in their quality of life scores, although the multisite repair group showed a trend toward greater benefit. The overall complication rate was lower in the multisite repair group (7.6% vs. 16.0%, p= .194). Multisite repair was associated with favorable anatomical and subjective outcomes and may represent a mesh-free option for women with predominant anterior prolapse. Given the potential confounding factors and coexistence of multicompartment defects, these findings require confirmation in well-controlled prospective studies. Multisite repair was associated with favorable anatomical and subjective outcomes compared to anterior colporrhaphy in women with anterior prolapse, supporting further evaluation of this native tissue approach as an alternative surgical technique.