Urinary incontinence is becoming more preva- lent as the population ages. Conservative estimates indicate that it affects nearly 20% of women age 40 to 60 years and 35% of noninstitutionalized women older than 60 years. 1 In most of these women the dis- order is secondary to genuine stress incontinence, detrusor instability, or a combination of both. No general agreement exists about the surgical procedure of choice for women with genuine stress incontinence. Many different techniques have been described but most are variations on seven basic themes: bladder buttress operations associated with Kelly and Pacey, the Marshall-Marchetti-Krantz procedure, colposuspension as described by Burch, long-needle suspensions without endoscopic control associated with Pereyra, long-needle suspension under endoscopic control associated with Stamey, sling pro- cedures, and periurethral injections. 2 Retropubic urethral suspension was performed laparoscopically. 3,4 This approach is ideally suited to surgery in the retropubic space. It provides excellent retropubic exposure, and videolaparoscopic magnifi- cation enhances the surgeon’s ability to place sutures precisely. Improved exposure enables restoration of support with limited mobility and avoids urethral obstruction and compression. The objectives of this study were to compare laparoscopic and open modified Burch colposuspen- sions with respect to outcomes, complications, and morbidity. 99 February 2001, Vol. 8, No. 1 The Journal of the American Association of Gynecologic Laparoscopists From the Department of Obstetrics and Gynecology, Minimal Access Surgery Unit, Ain Shams University School of Medicine, Abbassia, Cairo, Egypt (all authors). Address reprint requests to Hisham Fatthy, M.D., Central Heliopolis Office 11757, P.O. Box 344, Cairo, Egypt; fax 202 274 9603. Accepted for publication August 23, 2000. Abstract Study Objective. To compare results of laparoscopic Burch colposuspension with those of classic Burch colpo- suspension, and to assess complications, results, and morbidity associated with each procedure. Design. Prospective, randomized study (Canadian Task Force classification I). Setting. Minimal access surgery unit. Patients. Seventy-four women with genuine stress incontinence. Intervention. Laparoscopic and classic Burch colposuspensions. Measurements and Main Results. Mean operating times for laparoscopic and open surgery were 70.18 ± 16.54 and 53± 10.05 minutes, respectively (p <0.001). Mean blood loss was 42.75 ± 7.2 and 240.5 ± 35.5 ml, respec- tively (p <0.001). Postoperative analgesia requirement was significantly less with laparoscopy (p <0.001). Mean postoperative hospital stay was 36 ± 6.3 hours for the laparoscopic group and 76± 10.4 hours for the open group p<0.001). Average time to return to light work was 8.5 and 31.5 days, respectively. Success rates were 90.9% at 6 months and 87.9% at 18 months in the laparoscopic group, compared with 90% and 85%, respectively, in the open group. Conclusion. Given equal efficacy of the two procedures, we prefer the laparoscopic approach since it is associ- ated with lower morbidity, shorter hospital stay, and fewer complications. (J Am Assoc Gynecol Laparosc 8(1):99–106, 2001) Modified Burch Colposuspension: Laparoscopy versus Laparotomy Hisham Fatthy, M.D., MRCOG, Mounir El Hao, M.D., Ibrahim Samaha, M.D., and Khaled Abdallah, M.D.