This study was conducted to report on the safety and efficacy of a transobturator sling approach for treatment of urodynamic stress incontinence (USI). Women with urodynamic stress incontinence were offered a novel polypropylene mesh sling procedure, implanted beneath the lateral pubic rami rather than retropubically. Retrospective data were collected at three U.S. sites. Two hundred women with a mean age of 59 years (range 27–93) underwent the sling procedure. Mean follow-up was 21.5 weeks (range 3–43). Perioperative safety parameters are reported for all subjects and efficacy parameters for those who were followed up for 26 weeks or more. Among the subjects, 95.3% reported being continent or substantially continent (occasional leakage of small amounts, with protection not needed). Mean operative time was 13.8 min (range 7–34). Preoperatively, 75% wore pads, with 5.3% continuing to do so at 26 weeks. Pre-op urgency was reported by 62.7%, with 41.5% receiving medication. Urgency was reported postoperatively by 20.5% of patients, but only 13.6% were medicated for urgency. Urinary retention was identified in 0.9% at 26 weeks. Transobturator slings are highly effective for treatment of SUI, and may offer increased safety relative to traditional and tension-free retropubic slings.