Abstract Objectives To assess the efficacy and complications of TVTO with or without anterior colporrhaphy in women with urodynamic stress incontinence at 4 years follow up. Study design Seventy-four patients were subjected to TVTO operation and 41 patients to TVTO and anterior colporrhaphy. Subjective and objective cure and improvement rates and the incidence of complications were assessed. Results The objective cure rate based on the pad test findings for the TVTO-only patients was 82.4% and the improvement rate was 6.8%. The objective cure rate for the group undergoing TVTO and anterior colporrhaphy was 80.5% and the improvement rate was 7.4%. Conclusions At 4 years follow up TVTO procedure alone or with anterior colporrhaphy maintains a high cure and improvement rate with a very low complication rate and appears to be a promising technique, but long term results should be published for safer conclusions to be made.