Objective This study aims to evaluate safety and efficacy of four arms polypropylene mesh in the long- term follow-up in the management of stress urinary incontinence (SUI) associated with cystocele. Material and methods This prospective study was conducted on 50 female patients with SUI associated with cystocele. Patients underwent placement of transobturator four-arms mesh implants. Stress incontinence was evaluated using cough stress test with and without prolapse reduction, Stamey’s grading of SUI, the validated Arabic version of the International Consultation on Incontinence Questionnaire-Short Form and King Health Questionnaire forms. Perioperative parameters evaluated included age, body mass index, grade of SUI, time of procedure, hospital stay after surgery, difference between pre-, and postoperative serum hemoglobin values, and need for blood transfusion. Follow- up visits were planned at 3, 6 and 18 months after surgery. Results The mean operative time was 37.4±10.2 (25–60) minutes. Blood transfusion was not required. The mean hospital stay was 30.5±10 (24–48) hrs. Five (10%) patients had fever and urinary tract infections were noticed in five (10%) patients. Two (4%) women had urine retention after catheter removal and vaginal mesh erosion was present in one (2%) patient. Forty (80%) patients were cured from SUI, 8 (16%) patients were improved and 2 (4%) patients failed to respond. Conclusion Cystocele associated with SUI can be repaired with transobturator four-arms mesh with promising results, improved quality of life, and tolerable side effects.