We sought to compare rates of recurrent cystocele following sacrocolpopexy with and without paravaginal repair (PVR). This retrospective cohort study compared outcomes for patients undergoing sacrocolpopexy with (group A) and without (group B) concomitant PVR. Defining anterior failure as point Ba > or = -1 cm, we compared anatomic outcomes and reoperation rates for recurrence of cystocele. One hundred seventy patients undergoing sacrocolpopexy had anterior wall prolapse at or beyond the hymen before surgery (62 in group A and 108 in group B). Ten (16.1%) patients in group A and 29 (26.9%) in group B experienced anterior wall prolapse to or beyond -1 cm (p = 0.13, power 0.38). Among these groups, one (1.6%) and five (4.6%) underwent reoperation for cystocele recurrence (p=0.42, power <0.3). Despite the trend toward improved clinical outcomes, we were unable to detect a statistically significant difference with inclusion of PVR with sacrocolpopexy.