Objective: The aim of this study was to compare a modified Burch procedure with a suburethral sling for the treatment of stress incontinence complicated by a low-pressure urethra. Study Design: Thirty-six women with stress incontinence, low-pressure urethra, and urethral hypermobility (straining cotton swab angle ≥30°) were randomly assigned to undergo either a modified Burch procedure (n = 19) or a suburethral sling (n = 17). Objective and subjective cure rates at 3 months after the operation were the primary outcome measures. Comparisons of group means were performed with the Student t test for independent groups, and proportions were compared with the Fisher exact test. Results: After the operation the 2 groups had statistically similar cure rates and voiding function. Urethral closure pressure, pressure transmission ratios, and maximum detrusor pressure during voiding were significantly higher in the sling group. Conclusion: At 3 months there were no clinically significant differences between the groups treated with suburethral sling and modified Burch procedures. (Am J Obstet Gynecol 2000;182:30-4.)