Introduction: Pelvic organ prolapse (POP) can cause significant symptoms and affect quality of life (QoL). Approximately 1 in 10 women will require surgical intervention for POP or incontinence over their lifetime and 30 percent of these women will require reoperation for failed procedures. In response to high rates of recurrence, surgeons have historically attempted to improve outcomes with grafts or mesh.  However, the recent controversy and complications associated with mesh repair sparks the need for innovation in this field. Furthermore, with the aging population it is expected the economic costs of POP surgeries will continue to grow and thus, techniques aiming to improve outcomes or reduce recurrence are valuable from a health economics point of view. 
There's been a growing interest in biological graft repairs however studies assessing their efficacy demonstrate mixed results. 
Our study aims to find a solution to this problem. We present a novel surgical technique utilising autologous vaginal graft, this has not yet been described in the literature. 
Objectives: To report 10-year outcomes of vaginal autologous prolapse reinforcement with autologous vaginal graft (VAPR technique). 
We hypothesise onlay autologous graft supports fibrosis and strengthens the repair to improve success rates but without the morbidity of mesh.

Methods: Records were retrospectively reviewed for all patients who underwent vaginal repair with harvested vaginal graft (VAPR technique) between 2014 to 2024 by a single surgeon from two institutions. Patients undergoing anterior or anterior with posterior vaginal prolapse repair were included. Patients with vault or cervical prolapse were excluded. Operative time, rate of complications and outcomes have been assessed in our cohort of patients and compared against the available literature. 
Patient reported outcomes using validated prolapse QOL questionnaire (P-QOL) were also captured.

Results: 97 patients were included in the study (n=73 anterior vaginal prolapse repair, n=21 anterior and posterior vaginal prolapse repair, n=3 posterior prolapse repair). All women in our study had grade 2 or 3 prolapse. Average operative time was 66 minutes. Complication rate were low at 2% (n= 1 required blood transfusion and n=1 had bladder base injury). 3 percent of women required a repeat operation for prolapse. We had no reported de novo stress or urge urinary incontinence post-operatively. 2 patients reported de novo dyspareunia post-operatively.

Considering the high prevalence of POP as a condition and the high failure rates associated with traditional colporrhaphy, it’s necessary to be innovative and find surgical solutions that offer longevity and safety. Our data shows that transvaginal repair with autologous vaginal graft is a safe and effective option for prolapse repair. 
Our surgery rate for recurrence was low at only 3%. 2 patients required a re-operation at the 1 year mark and 1 patient required a re-operation at the 3 year mark. Furthermore, our survey revealed that 97% of respondents felt their symptoms of prolapse improved/ no recurrence after vaginal prolapse surgery. Our success rates are potentially comparable if not better than mesh, but without the associated morbidity.

Conclusion: VAPR technique is highly effective and safe, our success rates are potentially comparable if not better than mesh, without the associated morbidity. Our technique is easy to teach and cost-effective, this can be performed anywhere in the world including developing countries. Thus, we present a favourable novel autologous vaginal graft augment technique for pelvic prolapse surgery in light of the recent mesh controversy.