Though abdominal colposuspension is an established operative procedure in the therapeutic spectrum of female urinary stress incontinence, there is controversy concerning new access routes and fixation techniques. On the basis of a comparison between results of a "feasibility" study at our department concerning the trans- and extra-peritoneal endoscopic access as well as suspension techniques with alloplastic material and suturing vs. stapler application, and al literature survey, a synoptic concept is being evaluated. In case of critically made indication, first trends show that results of laparoscopically and retziusscopically assisted techniques are comparable to those of conventional procedures. However, the lack of long-term results as well as an initially prolonged operation time have to be considered. In the meantime an extraperitoneal transumbilical colposuspension was attempted in 2 patients, already unsuccessfully operated upon (conventional Burch) previously. Due to extensive perivesical adhesions a laparotomy had to be performed. The limits of the endoscopic approach seen to be reached in these cases.