To assess the medium-term performance of the Uretex Urethral Support System, patients were evaluated by the 1-h pad test, cough stress test (CST), Valsalva leak-point pressure test (VLPP), and validated questionnaires. Seventy-five patients were enrolled; median follow-up was 3.6 years (range, 3.1-4.3 years). All patients had a negative CST, 65 (87%) had no leakage during VLPP, and 62 of 72 patients (86%) had a negative 1-h pad test. Compared with baseline values of 50.0 and 28.6, median Urogenital Distress Inventory and Incontinence Impact Questionnaire-7 scores at 3-year follow-up were 16.7 and 0, respectively (P<0.001). Observed medium-term morbidity included de novo urgency in four (5%), frequency in three (4%), and urge incontinence in one (1%). No patients reported graft erosion. The Uretex Urethral Support System is highly effective (both objectively and subjectively) for treatment of stress urinary incontinence and improves quality of life in women with minimal adverse sequelae.