Pelvic organ prolapse is a very common condition whose treatment could be conservative or surgical in relation to bothersome and severity experienced by a woman. Prolapse surgery is performed worldwide using different approaches and by different specialists. Success rate varies enormously in literature and mesh surgery has been proposed in the last decades to improve outcome. However due to complications graft procedures have been loosing more and more attractiveness and native tissue repair is returning to be considered the favourite way. In this lecture aspects related to efficacy and safety of native tissue repair in all the vaginal compartments will be covered. A comparison with mesh surgery will also be included.