Background
In spite of rapid growth in the use of vaginally placed mesh in pelvic reconstructive surgery, there are few reports on the long‐term efficacy and safety of mesh‐augmented repairs.

Aims
To compare the long‐term outcomes of modified pelvic floor reconstructive surgery with mesh (MPFR) versus traditional anterior–posterior colporrhaphy (APC) for the treatment of pelvic organ prolapse (POP).

Methods
This retrospective cohort study involved 158 women who underwent surgical management of prolapse with MPFR (n = 84) or APC (n = 74) in the period between January 2007 and June 2008. Main outcome measures included pelvic organ prolapse quantification measurement, Short Form‐20 Pelvic Floor Distress Inventory (PFDI‐20), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) questionnaires, perioperative outcomes, complications and a personal interview about urinary and sexual symptoms. Statistical analysis included comparison of means (Wilcoxon test or Student’s t‐test) and proportions (χ2 test).

Results
Anatomical success rate for MPFR and APC was 88.1 versus 64.9% (P = 0.001), with a median follow‐up of 55 versus 56 months (range 49–66 months, P = 0.341). Both operations significantly improved quality of life, and a greater improvement was seen in MPFR group than in APC group (P = 0.013). Complication rates did not differ significantly between the two groups. The mesh erosion rate was 3.6%.

Conclusion
Modified pelvic floor reconstructive surgery with mesh had better anatomical and functional outcomes than APC at 4–5 years postoperation, as an alternative, cheap and effective treatment option to mesh kits for the management of POP.