We have previously reported preliminary (9 month) results using the tissue fixation system (TFS) in patients with stress incontinence. The aim of the study was to assess the effectiveness of the TFS in patients with genuine stress incontinence at 3 years. The TFS uses two small plastic anchors to fix a (adjustable) midurethral polypropylene mesh sling into the pelvic muscles and tissues below the retropubic space. Thirty-six patients with stress incontinence, mean age 55 (35-87), mean weight 76 kg, (33-117 kg), mean 0.8 previous operations for stress incontinence, underwent a TFS midurethral sling operation between 2003 and 2004. The suburethral vaginal fascia was also tightened. The patients were contacted by telephone independently by a nurse. The critical question was "Do you leak when you cough?" A negative answer was taken as a cure. If she said "sometimes", she was asked on a scale of 1 to 100 what her improvement was. Of the 31 patients contacted, total symptomatic cure was reported by 25 patients (80%) and >70% cure in a further two patients (6.5%). Five patients could not be contacted. There was a slight deterioration in cure rate for stress incontinence between 9 months and 3 years, similar to that seen with retropubic midurethral sling surgery.