INTRODUCTION AND OBJECTIVES: In the midurethral sling era, treatment of stress urinary incontinence (SUI) has increased dramatically. Concomitantly, use of the autologous rectus fascia pubovaginal sling (PVS) has decreased proportionately. However, for patients with intrinsic sphincter deficiency (ISD), recurrent SUI, or mesh complications, PVS remains an important procedure. We evaluated the outcomes of PVS in patients with ISD and/or recurrent SUI. METHODS: A retrospective review of prospectively collected data of patients undergoing PVS for SUI was performed. Patients were followed by mailed questionnaire annually. Success was defined as less than one incontinent episode per week or greater than 70% patientreported improvement from baseline. Patient-reported dry rate was assessed using the Urinary Distress Inventory (UDI-6) questionnaire. Secondary outcomes were complication rates. RESULTS: Between 1999 and 2014 we identified 82 patients who underwent PVS with a minimum follow up of 12 months. Mean age was 60 (range 34-87). 63% had recurrent SUI and 78% had ISD, defined as Valsalva leak point pressure (VLPP) <60 cmH2O (mean VLPP 37, range 0-58). At 6.1 years mean follow-up (range 1.4-11.0), the success rate was 74%, and patient-reported dry rate was 35%. Seventeen patients (23%) experienced a total of 20 peri-operative complications including 3 wound infections, 2 UTIs, 2 transfusions, 1 vaginal sling exposure, 1 small seroma that was drained, 1 abdominal wall hematoma, and 1 case of pneumonia. Rate of transient urinary retention was 9%, and 2% of patients had prolonged obstruction requiring intervention. In terms of postoperative urgency, 29% had de novo urgency but 17% had resolution of preoperative urgency. CONCLUSIONS: PVS is associated with a good success rate at long-term follow-up, even in more complicated and severe cases. Complication rate was low, but potential for retention and de novo urgency mandates careful preoperative counseling. PVS remains an important tool in the armamentarium for treatment of SUI.