All cases of stress urinary incontinence (SUI) are not the same; urethral pressures, prolapse conditions, and congenital and acquired sphincteric dysfunction all contribute to SUI pathophysiology. In order to optimally manage SUI, a thorough understanding of the pathophysiology behind the condition is necessary. Unsuccessful treatment of incontinence can result from the procedure itself or from a poor fit between the patient's condition and the treatment chosen. Proper patient evaluation, including videourodynamics and measurement of Valsalva leak point pressure, is key to making the best treatment decisions and obtaining optimal patient outcomes.