Fifteen women with a clinical and urodynamic diagnosis of stress urinary incontinence had a negative Q-tip test (greater than or equal to 30 degrees Q-tip angle change on straining). All 15 had retropubic surgical procedures for stress incontinence in the form of a revised Pereyra procedure (n = 6) or Burch retropubic urethropexy (n = 9). Five of the nine patients undergoing the Burch procedure (55%) and three of the six undergoing the Peyreya procedure (50%) failed the procedure, for an overall failure rate of 53%. This rate was five times higher than that among women with stress urinary incontinence and a positive Q-tip test who underwent the same procedures (P less than .01). We conclude that women with stress urinary incontinence and no anatomic defect in the support of the urethrovesical junction should not undergo retropubic procedures because of their high failure rate. Other occlusive procedures, such as sling operations, should be considered for this group.