Mid-urethral slings are commonly used in the surgical management of stress urinary incontinence. This multicentre, randomised trial aimed to compare the safety and efficacy of the retropubic tension-free vaginal tape (TVT) with the transobturator tension-free vaginal tape (TVT-O) in a group of patients with stress urinary incontinence, followed up over a five-year period. The same type of tape was used in both groups, with procedures performed under local anaesthesia with sedation to allow for intraoperative cough stress test and tape adjustment. Primary outcomes were objective treatment success (negative cough stress test, negative 24-hour pad test and no further intervention for stress urinary incontinence), and subjective treatment success (based on patients reporting if the procedure had met their expectations, and quality of life questionnaires). Complications, including infections, erosions and new onset urgency, were also recorded. In total, 273 patients were randomised with 268 patients undergoing their allocated procedure (136 TVT vs. 132 TVT-O). 94.8% of patients were followed up for five years. Objective and subjective treatment success rates were >80% in both treatment groups, with no significant difference between the two groups. Rates of postoperative complications were low, and similar between the two groups. No tape erosions were recorded. This study has demonstrated high levels of patient satisfaction with both types of mid-urethral sling, with little difference in postoperative outcome between the two groups. The procedure offered to patients may therefore depend on individual surgeon’s experience, in the knowledge that both procedures carry comparable success rates.