OBJECTIVE Reported success rates of the Stamey bladder neck suspension procedure vary from 39 to 91%. The disparity is substantially influenced by the methods used to assess the surgical outcome, with best results being found consistently in retrospective chart review studies. We assessed the true long-term outcome of the Stamey bladder neck suspension with a patient questionnaire based outcome analysis using strict definitions for cure and recurrence. METHODS Of 172 consecutive patients 138 (80.2%) returned a questionnaire designed to assess the outcome of the procedure and the subjective satisfaction with the operative result. To our knowledge we report the longest mean followup for this procedure (66 months). RESULTS Of 130 evaluable patients with hypermobility or intrinsic sphincter deficiency leading to urinary stress incontinence 65 (50.0%) remained completely continent, 15 (11.5%) never became continent and 50 (38.5%) had recurrence 6 to 90 months after initial operative success. However, approximately two-thirds of the patients believed they were cured or substantially improved more than 5 years postoperatively. CONCLUSIONS Despite the considerable failure rate, the substantial improvement in the quality of life of almost two-thirds of the patients during long-term followup and the lack of superior techniques qualify the Stamey bladder neck suspension as a treatment of choice for urinary stress incontinence in women. We strongly emphasize the need for standardized questionnaire based outcome analyses for the evaluation of incontinence surgery.