In this prospective, randomized trial, 3 different techniques of colposuspension for treatment of stress urinary incontinence were compared, including open Burch colposuspension (OC), laparoscopic colposuspension using sutures (LCS), and laparoscopic colposuspension using mesh and staples (LCM). Study patients were recruited over a 4-year period, 1996 to 2000, from the incontinence unit of Sahlgrenska University Hospital. Eligibility required a diagnosis of genuine stress incontinence or mixed incontinence with a predominant stress component. Patients with recurrent incontinence, detrusor instability, or who were planning to have major gynecologic procedures with colposuspension were excluded. Concurrent posterior colporrhaphy, sterilization, and adnexal surgery were acceptable. For the first third of the study, the lack of sufficiently trained operators necessitated a randomization pattern of 2 OC to one LCS to 2 LCM. When sufficiently trained surgeons were available, the pattern was changed to 1:2:1. At the end of the study period, 79 women had been randomized to the OC group, 53 to the LCS group, and 79 to the LCM group. Sixteen patients in the OC group and 4 patients each in the LCS and LCM groups were excluded before surgery for personal reasons or eligibility concerns. The final proportions for the colposuspension procedures were 63 OC, 49 LCS, and 75 LCM. Objective measures of incontinence included a self-completed 48-hour frequency-volume chart, a 48-hour pad test, a standardized stress test, urodynamics, the Bohr's ice-water test, and measurement of residual volume by catheterization. A patient-recorded leakage diary and a visual analog scale describing the impact of incontinence on quality of life were used for subjective assessment. Data were analyzed using the Tukey Kramer studentized range test and were considered significant at the 5% level. All surgeries were performed according to standard techniques. Well-experienced senior surgeons performed all procedures. Patient characteristics for each treatment group were comparable. Anesthesia time and operative time were significantly greater in the LCS group compared with the OC group (132 minutes and 84 minutes vs 112 minutes and 66 minutes, respectively). Blood loss was significantly greater with the open Burch technique compared with the other 2 (OC = 121 mL, LCS = 42 mL, and LCM = 31 mL). The use of mesh and staples resulted in significantly fewer days of bladder drainage (LCM = 1.9 days, OC = 5.9 days, and LCS = 6.2 days) and significantly fewer hospital nights (2.1 nights, 3.9 nights, and 3.3 nights, respectively) than the techniques using sutures. Complications, including bladder perforation, hematoma leading to reoperation, urinary tract infection within 1 month, and wound infections, were not significantly different among the groups. However, only 8% of the women in whom mesh and staples were used had more than 5 days of urinary retention, significantly less than the 27% of women in the open technique group and 39% of those who had colposuspension with sutures who had more than 5 days of urinary retention. Follow-up examinations at 1 year after surgery found that 37% of the women who had undergone laparoscopic colposuspension using mesh and staples had urinary leakage greater than 5 g at the stress test compared with 8% and 10% of those who had an open procedure or a laparoscopic procedure using sutures, respectively. Subjective assessment measures showed greater improvement in symptoms for women who had procedures using sutures than did women who had mesh and staples. Overall satisfaction with the treatment was expressed by more than 90% of the patients who had techniques using sutures compared with 72% of those in whom mesh and staples were used. The numbers of women who would recommend their treatment to a friend were similar in all 3 groups.