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Introduction and hypothesis: The aim of this study was to assess the 36-month safety and efficacy of a lightweight polypropylene mesh used for the transvaginal repair of stage III-IV cystocele. Methods: A multicenter prospective cohort study was performed. Preoperative assessment included an interview and evaluation with the Pelvic Organ Prolapse Quantification (POP-Q) system. Inclusion criteria were stage III-IV cystocele and no contraindications for mesh use. A lightweight (28 g/m) four-arm transobturator polypropylene mesh was used for the study. Pre- and postoperative symptoms and quality of life were assessed using the Urinary Symptoms Measurement (MHU), Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The main endpoint was mesh safety. Secondary endpoints were anatomic (Ba point ≤ −1) and functional success. Results: In all, 111 patients with a mean age of 67 ± 9 years (range 47-89) were included in the study, and 94 (84.7 %) were included in the analysis. Two intraoperative complications occurred (one bladder and one rectal injury, 2.2 %). Medium-term analysis of 79 patients (84 %) after 36 months showed a satisfaction rate of 98.7 % (78/79), a mesh contraction rate of 5.1 % (4/78), only one case of vaginal mesh exposure (1.3 %), no cases of chronic pelvic pain, and a postoperative dyspareunia rate of 2.8 % (1/36). The anatomic success rate of cystocele repair was 75/79 (94.9 %) and a highly significant improvement was noted for symptoms and on quality of life questionnaires. Overall, 7/79 patients (8.9 %) were reoperated, including 1 for hemorrhage, 1 for vaginal mesh exposure, 3 for stress urinary incontinence, and 2 for cystocele recurrence (2.5 %). Conclusion: Transvaginal cystocele repair using a lightweight transobturator polypropylene mesh was safe and efficient in the medium term. Long-term data and comparative studies are needed. [ABSTRACT FROM AUTHOR]