Introduction and Hypothesis <p>Uterine preservation during pelvic organ prolapse (POP) repair is increasingly preferred, with sacrospinous hysteropexy (SSH) being a successful option. SSH can be performed via anterior or posterior approaches.</p> Methods <p>This retrospective study compared outcomes of two SSH techniques involving synthetic mesh: anchorage to the anterior cervix only (SSH-A) and anchorage to both anterior and posterior cervix (SSH-AP). A total of 113 women with symptomatic Pelvic Organ Prolapse Quantification stage ≥ 3 underwent sacrospinous ligament fixation with synthetic mesh—55 in the SSH-A group and 58 in the SSH-AP group.</p> Results <p>Baseline characteristics were similar between groups. SSH-AP had a longer mean operative time but comparable blood loss, hospital stay, and follow-up duration. No major complications were reported. At 1-year follow-up, subjective cure rate was significantly higher in the SSH-AP group (98.3% vs 89.1%, <i>p</i> = 0.019), whereas objective cure rates were similar. De novo urge and stress urinary incontinence were more common in SSH-A (25.9% vs 4.2%, <i>p</i> = 0.037). Quality-of-life scores (Urogenital Distress Inventory 6, Incontinence Impact Questionnaire 7, Pelvic Organ Prolapse Distress Inventory 6) were also poorer in the SSH-A group.</p> Conclusions <p>Both approaches provided good clinical outcomes, but SSH-AP was superior in terms of subjective cure, lower incontinence rates, and quality of life.</p>