Objective To investigate ultrasound features following TOT ( outside-in) and TVT-O (inside out) surgery. Design A randomised prospective study Setting Private clinic in Population From May 2021 to May 2023, 49 patients underwent TOT and 48 underwent TVT-O. Methods Ultrasound exams and ICIQ-SF assessments were conducted during the sixth month postoperatively. Main outcome measures The mesh’s position along the urethral length and its distance from the urethra were recorded. Additionally, bladder neck mobility, bladder neck descent, pubourethral distance, urethral thickness, and bladder descent were measured pre- and postoperatively. Results Both groups had similar demographics (p > 0.05). No significant difference was found in sling placement percentiles between the groups (p > 0.05). However, urethral distances differed significantly (Z=-2.207; p=0.027), with TOT patients having greater distances than TVT-O patients (p < 0.05). There was no significant difference in pre- and postoperative ICIQ-SF values within each group (p > 0.05). Conclusion Our study found a significant difference in mesh-urethra distance between TVT-O and TOT procedures, but this did not affect postoperative questionnaire results.