OBJECTIVES: This report analyzes the functional and anatomic results of the anterior compartment when Burch retropubic urethropexy or paravaginal repair are performed at the time of sacrocolpopexy. STUDY DESIGN: A retrospective chart review of 65 women undergoing sacrocolpopexy for repair of symptomatic prolapse was performed. Pertinent subjective and objective parameters were abstracted preoperatively and postoperatively. History, including symptoms, physical findings, and urodynamic testing were performed in an identical manner preoperatively and 3 months postoperatively. RESULTS: Sixty-five women (mean age 62 years [range 29 to 89 years]) underwent sacrocolpopexy. Preoperative and postoperative symptoms included protrusion (100% and 3%, respectively), stress urinary incontinence (60% and 16%), urge incontinence (51% and 28%), and voiding dysfunction (14% and 3%). Anterior and apical prolapse protruded beyond the hymen in 85% of patients preoperatively and in 3% postoperatively. Urodynamics diagnoses were assessed preoperatively and postoperatively: genuine stress incontinence (80% and 13%, respectively) and detrusor instability (41% and 42%). The location of cystocele defects preoperatively and postoperatively was combined (38 and 10, respectively), pure lateral (24 and 1), pure midline (2 and 18), and none (1 and 46). CONCLUSIONS: Abnormalities in lower urinary tract function commonly exist in patients with apical support loss. A high cure rate for genuine stress incontinence can be obtained with retropubic repositioning. Cure rates for apical support are excellent, although anterior wall recurrences occur. The preoperative diagnosis of cystocele location appears problematic and warrants further study.