Summary The development of a new operation for certain types of urinary incontinence has been described. A preoperative test, consisting essentially of temporary elevation and fLxation of the vesical neck and urethra, has permitted the selection of those candidates who have an excellent chance for improvement by the operation, and which at the same time seems to indicate those whose postoperative result will not be good. The operation is a simple elevation and immobilization of the vesical neck and urethra by suturing them to the pubis and rectus muscles. Of 44 suitable cases excellent results were obtained in 36 (82%), significant improvement in 3 (7%), and no improvement in 5 (11%). The causes of most of the failures seem evident and are discussed. The most significant group reported consisted of 25 patients with the common variety of female stress incontinence which had failed to be corrected by one or more standard gynecological procedures for incontinence. Of these 25 patients, 19 have normal control from 1 to 35 months after this new operation with 21 having been followed 6 months or more. Poorer urinary control did not result in any instance. It is not the intent of this presentation to advocate this operation to the exclusion of others. As can be seen, the procedure is followed by failures in 10 to 15 per cent though careful use of the described preoperative test should permit better selection and thereby fewer failures. 1 The intent is to emphasize two principal points: first, that elevation and fixationZT the vesical neck is a major factor in the maintenance of urinary control; and, second, that this operation is worthy of trial in selected cases in which previously surgery has failed.