Fifty-one women with urodynamically proven genuine stress incontinence were alternately allocated to either colposuspension or a Stamey-type bladder neck suspension. One year after operation 89% of the patients who had had a colposuspension were subjectively cured and 73% were objectively normal. In the Stamey procedure group these figures were 76 and 40% respectively. The Stamey procedure is a quicker, simpler and a lesser procedure but has a higher incidence of post-operative voiding difficulties and residual urge symptoms. Colposuspension is to be preferred for the younger, healthier patient. The Stamey procedure is useful in the elderly, obese or unfit patient or the patient who has had multiple previous surgical attempts at a cure.