Background: stress urinary incontinence is a common problem affecting females; treatment varies between Burch colposuspension and traditional tot using synthetic materials. Objective: To evaluate efficacy and safety of autologous transobturator (ATO) rectus fascia sling as a primary treatment for female stress urinary incontinence. Materials and Methods: We evaluated the outcomes of 56 consecutive females who underwent ATO sling placement with rectus fascia for stress incontinence from July 2017 to September 2019 at the urology department – Al Azhar university hospitals (Alhussien – Sayed Galal university hospitals). Patients were followed in the outpatient clinic after one week, two weeks, 3 months and 6 months postoperatively. Outcomes were measured subjective by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score, and patient reported outcome and objective by cough stress test.      ICIQ-FLUTS were compared between pre- and postoperative responses using Wilcoxon signed-rank test. Retreatment-free survival rates were evaluated via Kaplan-Meier method. Results: The mean age of patients was 43.4 ± 7.04 years (29-56 years), 40 patients (71.5%) were premenopausal, and 16 patients (28.5%) were postmenopausal. The mean BMI was 29.2 ± 4.1 kg/m². The technique was performed and the patient was discharged the next day after surgery. Follow up for patients was carried out at one week, two weeks, three and six months postoperatively. All patients completed ICIQ-FLUTS at the last follow-up. Compared to preoperative scores, patients who completed ICIQ-FLUTS questionnaires at 6 months (N = 56) showed significant improvement in all domains: frequency, voiding, and incontinence, and in quality of life related to frequency, voiding and incontinence. Among those who completed questionnaires both at 3 months and 6 months after surgery (N = 56). There was no significant deterioration in ICIQ-FLUTS scores. Overall retreatment-free survival rate was 93% at six months. Notably, none of our patients suffered from severe (Clavien III-V) complications or required sling release. Conclusion: ATO sling placement appeared safe and effective, with promising short-term outcomes. However, long term follow-up is needed.