Objective To Investigate the effectiveness of transobturator inside-out tension-free urethral suspension for the treatment of female stress urinary incontinence. Methods Eighteen cases were operated on with urethral suspension by using transobturator artificial meshes from August 2005 to February 2006. Dissection was performed alongside the urethra bilaterally by way of the anterior vaginal wall. A transobturator mesh was passed through the vulva and was positioned without tension underneath the urethra. Results The operative time ranged 10~25 min (mean, 15?3 min), and the estimate blood loss was 10~20 ml (mean, 15?2 ml). An indwelling catheter had been used for 3 d because of urinary retention in 1 case. All of the patients were successfully cured and normal voiding without complications was achieved postoperatively during 6 months of follow-up. Conclusions Transobturator inside-out tension-free urethral suspension is simple and minimally invasive, with low complication rate and little risk of bladder injury. It is a safe and effective technique for the surgical treatment of female urinary stress incontinence.