BACKGROUND Anterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience urinary incontinence. OBJECTIVE To determine the effects of anterior vaginal repair (anterior colporrhaphy) on stress or mixed urinary incontinence in comparison with other management options. METHODS We searched the Cochrane Incontinence Group's trials register, and the reference lists of relevant articles. Date of most recent search: September 2000. METHODS Randomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence. METHODS Both reviewers independently extracted data and assessed trial quality. Two trial investigators were contacted for additional information. RESULTS Nine trials were identified which included 333 women having an anterior vaginal repair and 599 who received comparison interventions. A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with needle suspension appeared similar but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic retropubic suspensions, or compared alternative vaginal operations. Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the short-term (failure rate within first year after anterior repair 82/279, 29% vs 50/346, 14%; RR 1.89, 95% CI 1.39 to 2.59) and long-term (after first year, 132/322, 41% vs 68/395, 17%; RR 2.50, 95% CI 1.92 to 3.26). There was evidence from three of these trials that this was reflected in more repeat operations for incontinence (25/107, 23% vs 4/164, 2%; RR 8.87, 95% CI 3.28 to 23.94). These findings held irrespective of the co-existence of prolapse (pelvic relaxation). Later prolapse operation appeared to be equally common after vaginal (3%) or abdominal (4%) operation. In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension. CONCLUSIONS There were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in six trials, even in women who had prolapse in addition to stress incontinence (four trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about post-operative complications and morbidity.