OBJECTIVE To determine the frequency of de novo urgency after tension-free vaginal tape (TVT) compared with the transobturator tape (TOT) procedure in women with stress urinary incontinence (SUI). METHODS Prospective study of all consecutive women with urodynamically confirmed SUI undergoing anti-incontinence surgery between January 2000 and January 2008. All procedures were performed by experienced urogynaecologists well trained in TVT and TOT surgery. Assessments were carried out at 1, 6, 12 and, 36 months after surgery. RESULTS The study population included 366 women (mean age 59.5 years), 243 in the TVT group and 123 in the TOT group. The groups were similar in terms of demographics, preoperative data, and cure rates. De novo urgency occurred in 13.4% of patients at 6 months after surgery, in 19.3% at 12 months, and in 22.1% at 36 months. De novo urgency was significantly more frequent in the TVT group than in the TOT group at 12 (22.2% vs 11.2%, P=0.025), 24 (24.8% vs 12.3%, P=0.033), and 36 (0% vs 24.7%, P=0.034) months. Cure rates were similar in both groups. The final adjusted cure rate was 87.3% (319/366). CONCLUSIONS Treatment of SUI using the TOT procedure was associated with a lower rate of de novo urgency.