Background: Urinary incontinence poses a significant health concern globally, with stress urinary incontinence (SUI) being a prevalent subtype. Despite its impact on quality of life, many affected individuals do not seek medical attention, and treatment options vary, including surgical interventions such as synthetic mid-urethral slings and autologous pubovaginal slings. Methods: A randomized prospective comparative study was conducted at a tertiary care center over a 23-month period, involving 30 female patients with stress urinary incontinence. Patients were divided into two groups: Group A underwent polypropylene transobturator mid-urethral sling surgery, while Group B underwent autologous rectus fascia pubovaginal sling surgery. Demographic characteristics, preoperative, intraoperative, and postoperative assessments were recorded. Follow-up evaluations were conducted at one, three, and six months postoperatively. Results: Baseline characteristics were comparable between the two groups (p>0.05). Intraoperative assessment revealed a longer operating time in Group B compared to Group A (130.20 vs. 38.67 minutes, p<0.001). Postoperative outcomes showed a shorter catheter duration (2.20 vs. 3.40 days, p=0.0012) and hospital stay (3.33 vs. 4.47 days, p=0.0004) in Group A compared to Group B. Subjective resolution of urinary incontinence was comparable in both groups. Minor complications were reported in patients from Group A, irritating voiding symptoms (n=3), MESH erosion (n=1) and groin pain (n=1), while in both the groups a total of 3 patients reported transient urinary retention. Conclusion: Both polypropylene mid-urethral sling and autologous pubovaginal sling surgeries effectively treated stress urinary incontinence. While subjective resolution was high, polypropylene sling had shorter catheterization and hospitalization time. Minor complications occurred in both groups.