Objective: The purpose of this study was to prospectively assess the cases of patients who had undergone a high uterosacral suspension and anterior repair with anterior compartment placement of porcine dermis graft. Study design: Thirty-six patients who underwent transvaginal high uterosacral suspension and cystocele repair with graft augmentation from June 2001 to July 2004 were identified from the University of Alabama at Birmingham Genitourinary Disorders database. Analysis included the pre- and postoperative Pelvic Organ Prolapse Quantification examinations and incontinence impact questionnaire-7/urogenital distress inventory-6. Results: Mean Pelvic Organ Prolapse Quantification Ba improved from +3.3 ± 2.2 cm to -0.6 ± 1.7 cm (P < .01). Postoperative Ba was prolapse stage II or greater in 50% of subjects. Mean incontinence impact questionnaire-7 scores improved from 36.2 ± 31.9 to 15.6 ± 26.2 (P < .01), as did mean urogenital distress inventory-6 scores from 58.2 ± 26.8 to 23.8 ± 22.6 (P < .01). Conclusion: Significant improvements in Pelvic Organ Prolapse Quantification measures, urinary symptoms, and the impact of incontinence were seen after the operation. However, a significant proportion of patients had Pelvic Organ Prolapse Quantification stage II prolapse or greater, which made it unclear whether graft use confers a significant advantage. © 2006 Mosby, Inc. All rights reserved.