To detect incidental bladder or ureteral injuries, thought to be more common during abdominal urethropexy procedures, the addition of routine cystoscopy to the Burch procedure is frequently recommended. In this study, the medical records of 109 consecutive patients who underwent abdominal urethropexy with intraoperative cystoscopy were reviewed to investigate the incidence of lower urinary tract injuries and the value of cystoscopy during these procedures. An attempt was made to determine factors that might identify patients at risk of injury. Ten lower urinary tract injuries occurred among the 109 patients. One of these, a ureteral transection, occurred during dissection of an adnexal mass before the Burch procedure was started and was not considered to be related to the urethropexy. In six patients, transvesical placement of a colposuspension suture involving the bladder, usually at the bladder neck, was discovered during cystoscopy. The sutures were removed and replaced immediately. During dissection of the space of Retzius, there were two cystotomies, one of which involved the bladder dome and one that occurred in the lateral bladder wall. Neither was discovered during cystoscopy. One occurred and was recognized before cystoscopy, and the other was missed at cystoscopic examination but was discovered when seeping cystoscopic instillational fluid was observed in the pelvis. Both cystotomies were repaired intraoperatively with a two-layer closure using an absorbable suture. In addition to the ureteral transection during pelvic dissection, two other ureteral injuries occurred. In one patient, bilateral ureteral obstruction was identified at cystoscopy by the absence of indigo carmine efflux from either ureteral orifice. The sutures were removed and replaced with no further difficulties. A second patient, in whom the ureteral efflux was described as “sluggish” on one side, was subsequently found to have a unilateral ureteral obstruction that was not recognized during surgery. She developed pyelonephritis and hydronephrosis after surgery and underwent a second procedure to remove the urethropexy sutures. No factors that could be associated with an increased risk of injury during an abdominal urethropexy procedure were identified. Patients with and without injuries were similar in demographic and clinical characteristics, although there was a statistically insignificant greater number of previous pelvic surgeries among patients with injuries. Residents were present during nearly all of the procedures, but there was no indication that this caused problems. They were always under direct supervision of the attending urogynecologist, and there was no difference in the rate of injury associated with the experience of the supervising surgeon. Am J Obstet Gynecol 1999;181:35–38