Stress urinary incontinence (SUI) affects up to 50% of women. While synthetic mid-urethral slings (MUS) are effective, concerns regarding mesh-related complications have led to increased patient hesitancy and regulatory restrictions. Autologous fascial slings are a safer alternative but are more invasive. This study aims to evaluate the feasibility and safety of a Hybrid Transobturator Tape (H-TOT) technique, which combines an autologous rectus fascia segment with synthetic mesh arms placed via the transobturator route.

A rectus fascia graft (3 cm × 1 cm) was harvested via a Pfannenstiel incision. Polypropylene mesh (15 cm × 1 cm) was sutured to each end of the fascia. The autologous portion was positioned beneath the mid-urethra, and the mesh arms were passed through the obturator foramen using standard transobturator (TOT) needles. The tape was secured to the periurethral tissue using polyglactin 4-0 sutures. Feasibility, perioperative complications, early recovery, and subjective continence outcomes at 3 months were assessed.

The H-TOT procedure was successfully performed in all cases without intraoperative complications. The fascia harvest added 10–15 minutes to operative time. Early recovery was uneventful in all patients. At 3-month follow-up, all reported subjective improvement in continence. There were no instances of mesh erosion, extrusion, or significant postoperative pain.

The H-TOT technique was feasible and well tolerated in this initial series. By integrating an autologous central graft with synthetic mesh arms, this approach may provide a balanced alternative for patients seeking to avoid full synthetic implants. The technique maintains the minimally invasive advantage of the transobturator route while potentially reducing the risk of mesh-related complications.

H-TOT appears to be a safe and effective hybrid technique for the surgical management of SUI. It may serve as a suitable option for women who decline synthetic MUS due to safety concerns. Further long-term and comparative studies are needed to assess durability and continence outcomes.