To evaluate objective and subjective outcomes of patients who underwent sacrocolpopexy with autologous rectus fascia. Our cohort study included women who underwent abdominal sacrocolpopexy using autologous rectus fascia between June 2014 and December 2019 at a single academic medical center. Patients were recruited for a follow up visit including completing the Pelvic Floor Distress Inventory (PFDI) and Pelvic Organ Prolapse Quantification (POPQ) exam. Demographic and clinical characteristics were also collected. A total of 73 women underwent sacrocolpopexy with autologous rectus fascia during the study period. Mean follow up time was 2.3 years, ranging from less than a year to 6.2 years. Mean age was 59.1 years (SD = 9.0) and 80.6% were postmenopausal. Mean body mass index was 25.2 kg/m2 (SD = 3.5 kg/m2). This was the initial prolapse repair for most (71.2%) of the patients. At the time of the procedure, 54.8% of patients underwent a total hysterectomy, 16.4% had a supracervical hysterectomy, 63.0% underwent a concomitant Burch colposuspension, and 56.2% underwent a posterior colporrhaphy. Mean operative time was 201 minutes (SD = 50.8). PFDI scores were significantly improved from baseline (98.9 ± 54.0) to follow up (43.1 ± 42.7; P < 0.001). These improvements remained similar for patients with at least 3 years of follow up (115.5 ± 50.8 vs. 48.4 ± 48.9; P < 0.001). Preoperatively, 30.1% of patients presented with stage II prolapse, 63.0% with stage III prolapse and 5.5% with stage IV prolapse. On follow up, 20.8% had stage II prolapse, 1.4% had stage III prolapse and none had stage IV prolapse. All POPQ measurements except for total vaginal length were significantly improved from baseline (P < 0.001), and these improvements remained similar for patients with at least 3 years of follow up (P < 0.05). Complications included 20.6% with urinary tract infections, 6.8% with ileus or small bowel obstruction (1 patient requiring surgery), 2.7% with pneumonia, and 1.4% requiring blood transfusion. There were no surgical site infections. Immediate postoperative voiding dysfunction was present in 26.0% of patients. Five patients (6.8%) underwent subsequent surgery for stress urinary incontinence; one patient underwent additional surgery for prolapse. Sacrocolpopexy with autologous rectus fascia is a safe and effective alternative to synthetic mesh. Our results showed significant improvements in objective and subjective outcomes that were sustained over three years, with low rates of repeat surgery for prolapse.