The aim of this study was to investigate the incidence of operative injury to the lower urinary tract after retropubic urethropexy. We prospectively evaluated the incidence of lower urinary tract injury in 97 consecutive patients after pelvic surgery, which included primary Burch retropubic urethropexy. None of the subjects sustained intraoperative injury of the bladder or ureters as evidenced by an intact bladder mucosa and prompt efflux of dye from both ureteral orifices. In our experience, the incidence of lower urinary tract injury with retropubic urethropexy is low. We do not support the routine use of intraoperative cystoscopy with Burch retropubic urethropexy.