Treatment of female stress urinary incontinence has gone through revolutionary changes over the past 10 years. First described in Sweden by Ulmsten in 1995, the TVT procedure (Tension-Free Vaginal Tape, Gynecare, Somerville, NJ) has been used extensively in Europe and in the United States since clinical trials established its safety and effectiveness as an ambulatory surgical procedure for treatment of genuine SUI in women. Laparoscopic approaches to the Burch procedure have been mostly replaced by the mid-urethral TVT procedure as it has been found to be less invasive with higher cure rates. Surgeons, however, have continued to look for less invasive and safer alternatives to treat this problem in women and have recently discovered the transobturator approach for the tension-free vaginal tape sling. The sling material has not changed i.e., we know that the monofilament, macroporous polypropylene mesh material is the best tolerated material with over 1 million tapes of this material implanted worldwide with very low rates of infection or rejection. We have seen when the material is altered to a multifilament polypropylene mesh or a heat-bonded polypropylene tape (Obtape, Mentor Surgical, USA) with pore sizes < 75 microns that there is a high risk of infection or rejection of the tape and these type of materials should be avoided. However, when the same macroporous monofilament polypropylene mesh is used that was originally used with the TVT sling, the Transobturator approach to place a mid-urethral tension-free vaginal tape sling seems to be safer, more efficient, carry less risk of voiding dysfunction and offer the same cure rate of retropubic slings and therefore seems to be a viable treatment for female SUI. The procedure can be completed as in an outpatient type setting under local anesthesia and is allowing us to treat female SUI in a truly minimally invasive manner with very low risks.