Purpose <p>A modified total colpocleisis is one of the traditional surgical procedures for elderly women. The aim was to evaluate the long-term patient quality of life, body image, satisfaction, and regret rate after the surgery.</p> Methods <p>This retrospective study included women with advanced prolapse who underwent colpocleisis. The study analyzed the patients’ demographic characteristics, operation information, complications, and 3D-ultrasound information. The Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory-short form 20 (PFDI-20), and Modified Body Image Scale were completed preoperatively, at 3-month and annual follow-up visits to evaluate self-perceived quality of life. The Modified Decision Regret Scale and Global Impression of Change (PGI) questionnaire were evaluated to assess regret and satisfaction after surgery.</p> Results <p>Forty-two of the women (95%) were considered for statistical evaluation. No woman had experienced prolapse recurrence. Only one woman regretted having had the surgery due to the resumption of sexual activity while the sexual capacity was preserved and sexual function was improved postoperatively. De novo urinary incontinence was the most common complication (17.6%). The scores of PFIQ-7 and PFDI-20 decreased significantly (<i>P</i> &lt; 0.001), suggesting a positive impact on quality of life after surgery. We also found women with de novo urinary incontinence were more likely to have a bladder neck funneling in preoperative 3D ultrasound.</p> Conclusions <p>A modified total colpocleisis is a highly effective option for severe pelvic organ prolapse. After long-term follow-up, the surgical procedure has a high satisfaction rate, a low regret rate, and significantly improved body image and quality of life.</p>