Backgrounds: Stress urinary incontinence is a widely experienced condition among females. Our aim was to compare TOT and handmade needleless midurethral sling regarding safety and effectiveness for management of genuine stress urinary incontinence in females. Methods: Sixty female cases with genuine SUI randomly allocated to 2 groups: Group I: 30 patients were operated on using handmade needleless mid urethral sling (Prolene, Ethicon, USA) mesh 15 x15 cm by cutting 134 mm x 20 mm tape). Group II: 30 patients were using TOT (Obtryx transobturator sling system, Boston Scientific, USA) "outside-in" technique. Post-operative evaluation at 3, 6 and 12 months by cough stress test, post-voiding residual urine and uroflowmetry, a negative cough stress test with absence of urine leakage indicated cure.Results: Group I demonstrated a shorter Operative time than group II 14.17±2.82 min and 25.23±2.63 min respectively (P value <0.05) however, the postoperative hospital stay and complications were insignificantly different in both groups (P value <0.05). Also, insignificant differences were detected in both groups regarding cure, improvement and failure rate where the cure rate in group I was 90%, in group II was 86.7%, the improvement rate in group I was 6.7%, group II was 10% and the failure only affected one case each group.Conclusions: Handmade needleless midurethral sling is a good tool for treatment of genuine female stress urinary incontinence with encouraging results, less operative time, side effects and cost in comparison to commercial TOT especially in developing countries.