The open Burch procedure with its long-term success rates remains a gold standard for surgical treatment of genuine stress urinary incontinence. Less invasive Burch procedures require longer term follow-up studies with comparison to the open approach and tension-free vaginal tape before its role can be settled. At this point, tension-free vaginal tape appears to be at least equivalent to the Burch colposuspension and, with longer follow-up studies, may challenge its role as a gold standard surgical treatment for female stress incontinence.