Urodynamic stress incontinence is a common complaint. There have been over two hundred procedures described for treatment. In 2003, the Royal College of Obstetricians and Gynaecologists in London published a guideline highlighting the evidence for different surgical approaches. These guidelines are intended to guide practice in the United Kingdom, including the two countries that were surveyed. It was our impression however that more sub-urethral tape type procedures were taking place than was recommended. We therefore undertook a postal survey of the consultant gynaecologists in Scotland and Wales, to compare current practice with the evidence base, and also to assess practice from a clinical and manpower perspective. Two hundred and forty consultants were identified in Scotland (161) and Wales (79). About two-thirds of those who saw patients with stress incontinence would always arrange pre-operative physiotherapy, and the majority of consultants would always organise urodynamics preoperatively. There were several different choices of primary procedure, with Tension Free Vaginal Tape (TVT Gynecare- Johnson & Johnson) the most common option. More than half of the respondents in both countries would refer a patient with recurrent stress incontinence to a specialist. TVT was also the most common choice of procedure for recurrent stress incontinence. The procedures that have a grade A recommendation in the RCOG guideline are Burch colposuspension and TVT, and 72% in Scotland and 63% in Wales would perform one of these procedures as first choice. Clinical practice moves on and there are several new sub-urethral tape procedures available on the market. It is important to balance the available evidence base with new developments in order to optimise the management of this common condition.