OBJECTIVE To report long-term follow-up of 300 patients undergoing extraperitoneal retropubic bladder suspension using balloon distention and mesh suspension. METHODS Observational study (Canadian Task Force classification II-2). METHODS Private practice. METHODS Three hundred women with urinary incontinence. METHODS Extraperitoneal retropubic bladder neck suspension with mesh, after balloon distention of the space of Retzius performed under general anesthesia in 162 (54%) and epidural anesthesia in 138 (46%). RESULTS Eight procedures were converted to open urethropexy, resulting in 259 laparoscopic urethropexies. Spontaneous voiding resumed within 24 hours in 235 patients (90.4%). Follow-up was available for 267 patients and ranged from 1.5 to 5.5 years (mean 3.28 yrs). Of these, 173 women (67%) reported that they were cured and 64 (24.5%) were satisfied with the result; 22 (8.5%) were considered failures. CONCLUSIONS Extraperitoneal retropubic bladder neck suspension with mesh results in a durable repair and is associated with relatively short operating time, low morbidity, and excellent patient satisfaction. (J Am Assoc Gynecol Laparosc 8(1):107-110, 2001)