Anterior vaginal wall prolapse is defined as clinically evident descent of the anterior vaginal compartment. This may be the result of a midline, lateral or transverse fascial defect. Oftentimes, the patient does not experience symptoms until the anterior prolapse descends to the level of the introitus. Associated symptoms may include: pelvic pressure, palpation of a vaginal bulge, voiding difficulties (the need for positional voiding), urinary incontinence, and interference with sexual activity. Younger patients may complain of the inability to retain a tampon. Surgical correction of the anterior vaginal wall defect is indicated when the prolapse has a negative impact on the patient’s quality of life. The objective of the anterior colporrhaphy is to fold and tighten the layers of the vaginal muscularis and adventitia overlying the bladder (also called the pubocervical, pubovesical, or endopelvic fascia). This surgical procedure should be tailored to the specific site(s) of anterior compartment defect, and is most suited for the central (midline) defect. Patients should be assessed for stress urinary incontinence and other compartment defects, which can be corrected concomitantly. When compared to non-native tissue repairs, the anterior colporrhaphy is associated with fewer complications. It does have a higher long-term failure rate but is the recommended procedure for patients with no history of prior repairs.