Aims: To evaluate the surgical outcomes following total pelvic floor reconstruction (TPFR) and transvaginal hysterectomy (TVH). Materials and Methods: This was a retrospective cohort study of all patients who underwent TPFR or TVH repair for pelvic organ prolapse (POP) between January 2005 and January 2011. A total of 251 consecutive women were evaluated prior to, and at two, six, and 12 months after surgery. Anatomy, symptoms, and quality of life were measured using the Pelvic Organ Prolapse Quantification system (POP-Q) and pelvic floor distress inventory (PFDI). The surgical outcomes were compared between groups using Student’s t-test and ANCOVA tests (p < 0.05). Results: Of the 251 patients, 129 had a total pelvic floor reconstruction (TPFR group), and concomitant modified transobturator inside-out tension-free urethral suspension (TVT-O) was used in pelvic floor dysfunction patients with stress urinary incontinence. The patients that underwent vaginal hysterectomy surgery (TVH group) were 122. At two, six, and 12 months, respectively, 12.40% (TPFR group) and 18.85% (TVH group) of the patients were lost to follow-up. There were no significant differences between TPFR group and TVH group for all preoperative variables (p > 0.05). The TPFR patients had significantly lower operation time, blood loss, anus exhaust time, remaining catheter time, and the length of stay in hospital (p < 0.05). Postoperatively, the recurrence rate in TVH group was higher than that of TPFR group after surgery at six and 12 months (p < 0.05). The PFDI score was significantly different between the groups. Conclusions: The short-term clinical results suggest that the two surgeries are safe and effective in treating female POP. The patients’ quality life was improved, but TPFR technique was more conspicuous for treating POP.