OBJECTIVE To compare two techniques of transperitoneal laparoscopic urethropexy. METHODS Prospective, randomized, open trial (Canadian Task Force classification I). METHODS University-affiliated department of gynecology and obstetrics. METHODS Sixty women with genuine stress incontinence. METHODS Transperitoneal laparoscopic retropubic urethropexy using nonabsorbable sutures (group A) and polypropylene mesh fixed with tacks or staples (group B). RESULTS Failure was assessed subjectively and objectively. Subjective evaluation was performed asking patients if they had urine loss and having them describe symptomatology on a visual analog scale before surgery and at each follow-up visit. Objective evaluation was by clinical examination and/or multichannel urodynamic studies. No significant differences in intraoperative and postoperative complications were observed between groups. The subjective failure rate was not significantly different between groups 3, 6, and 12 months after surgery. At 3 and 6 months the objective failure rate was not significantly different; however, at 12 months it was significantly lower in group A than in group B. CONCLUSIONS Transperitoneal laparoscopic retropubic urethropexy is more effective with sutures than with mesh.