To evaluate the 2-year outcome of laparoscopic Burch colposuspension in treating genuine stress incontinence, and to evaluate the prevention of subsequent vaginal vault prolapse by prophylactic apical vault repair. This is a prospective study of 48 consecutive cases diagnosed with genuine stress incontinence and followed for 2 years or longer (range 30 to 41 months) after correction by laparoscopic Burch colposuspension. All patients had a routine urogynecology evaluation, including preoperative and postoperative multichannel urodynamics. Follow-up testing was done at 6 weeks and 1 and 2 years. Result: At 6 weeks, 1 year, and 2 years, the cure rate for genuine stress incontinence was 98, 93, and 89%, respectively. There was a significant decrease in urethral hypermobility and an increase in urethral pressure transmission ratios. Thirty-nine (81%) patients voided spontaneously in less than 24 hours. There was no clinically significant pelvic organ prolapse at 2 years. The 2-year cure rate and multichannel urodynamics findings for laparoscopic Burch repair are similar to those reported for laparotomy. Early Result of prophylactic apical vault suspension suggest that the incidence of prolapse observed after routine retropubic urethropexies may be reduced.