OBJECTIVE: This study first aims to compare the outcomes of Surelift (anterior-apical transvaginal mesh) and sacrospinous ligament fixation (SSF) with anterior repair using objective and subjective cure rates. Second, to compare the quality of life and its major and minor complications. MATERIAL AND METHODS: A retrospective study was conducted between December 2011 and January 2020. Patients with symptomatic stage ≥ 3 anterior or apical prolapse were included. Those who had prior POP mesh and who were unfit for surgery were excluded. Preoperative evaluation included history and physical exam, urodynamic studies, and validated questionnaires (IIQ-7, UDI-6, POPDI-6) at baseline, 1, 3, and 5 years later. RESULTS: One hundred eighty-one patients were included: 98 underwent anterior-apical transvaginal mesh and 83 had SSF with anterior colporrhaphy (SSF+A). Anterior-apical transvaginal mesh and SSF+A patients had mean follow-up periods of 83.5 ± 6.1 and 91.6 ± 39 months, respectively. At 1 year, no statistically significant difference was noted in objective and subjective cure rates between anterior-apical transvaginal mesh (96.8% and 94.7%) and SSF+A (89.9% and 88.6%). However, after 3 and 5 years, anterior-apical transvaginal mesh showed superior results with objective cure rates of 94.1% and 89.1%, respectively, compared to 80% and 64.4% for SSF+A (p = 0.008). At 3 and 5 years, anterior-apical transvaginal mesh had 92.9% and 85.9% subjective cure rates compared to SSF's 77.1% and 60%, respectively (p = 0.005). CONCLUSIONS: The long-term follow-up showed that native tissue repair was strongly associated with increased risk of recurrence compared to the anterior-apical mesh with minor complications in both groups.