Objective:  To evaluate the safety and efficacy of transobturator vaginal tape (TOT) procedure in women with stress urinary incontinence (SUI).Methods:  The study population consisted of 210 patients who were diagnosed as having stress urinary incontinence, and they underwent a TOT operation alone (99) or concomitant vaginal surgery (101) between January 2005 and February 2009 and were followed up for at least one year. Patients with detrusor overactivity and intrinsic sphincter deficiency were excluded. The cure and complication rates were investigated.Results:  The mean follow‐up was 46.4 ± 8.7 months (range 13–48). No vascular, nervous system, or digestive perioperative complications were observed; however, 3.9% of the patients had voiding difficulty. The overall 12‐month objective cure and subjective cure rates were 89.0% and 89.0% respectively. The overall four‐year objective and subjective cure rates were 83.3% and 86.2% respectively. There was no difference between the four‐year objective and subjective cure rates when TOT alone was performed (83.8 and 86.9%) or when performed as part of another surgical procedure (82.9 and 85.6%).Conclusion:  The TOT procedure is a safe, effective and minimally invasive procedure for treating SUI with a low rate of complications. Moreover, it can be carried out safely and effectively in association with vaginal surgery.