OBJECTIVE: To investigate outcomes of cystocele surgery by different anesthesia and evaluation of patient satisfaction. DESIGN: Population-based, retrospective study. SETTING: All clinics that included patients in the Swedish National Register for Gynecological Surgery. POPULATION: A total of 1,364 women who underwent cystocele repair from January 2006 to June 2009. METHODS: The study population was retrieved from the Register among women who had surgery and where there was complete information on concurrently used anesthesia. Clinical variables were compared. Peri- and postoperative complications were investigated. Multivariate logistic regression analysis was applied to identify independent factors for patient satisfaction. MAIN OUTCOME MEASURES: Time to recovery, complications and patient satisfaction. RESULTS: We found a wide variation between hospitals with respect to use of local anesthesia (LA) in cystocele surgery. Length of hospital stay, duration of use of postoperative painkilling drugs, and patient-reported time to return to daily activity were shorter in the LA group compared to the other two anesthesia forms. Postoperative complications did not differ between groups. Age (> or =50 years) and patient-reported complications were independent factors related to patient satisfaction (OR 3.05; 95%CI 1.36-6.82 and OR 0.21; 95%CI 0.12-0.36, respectively). Patient satisfaction did not relate to methods of anesthesia. CONCLUSION: Cystocele surgery can be performed safely using LA thus limiting the use of more invasive anesthesia methods. LA benefits patients and should be increasingly used.