Percutaneous bladder neck stabilization (PBNS) represents a minimally invasive surgical procedure for the treatment of stress incontinence caused by hypermobility of the proximal urethra and bladder neck. Since the initial description of the procedure, technique and instrumentation modifications have added to the reproducibility of this operation. Three specific modifications have been incorporated into this procedure: strong anchoring of the suspension suture to the symphysis pubis using a bone anchor, incorporation of a broad segment of vaginal wall with a Z suture, and loose resuspension of the proximal urethra. Cystoscopic verification of suture location precludes bladder entry or distal suture placement. This procedure has been currently used in 71 women with an overall cure rate of 94% (no stress incontinence) at follow-up of 12 months. One retropubic abscess required drainage. A second patient required excision of a skin sinus tract cause by an infected bone anchor. Urinary retention of > 3 weeks has not been encountered. Overall morbidity has been minimal. Long-term follow-up of continence status and other procedure-related complications is ongoing. PBNS provides equivalent continence results and complication rates as compared with other retropubic and transvaginal procedures with a minimally invasive outpatient technique.