To investigate the application of tension-free urethral suspension surgery combined with modified vaginal wall repair in the treatment of female stress urinary incontinence. Female patients with stress urinary incontinence complicated with mild to moderate pelvic floor prolapse or vaginal laxity in our hospital from January to September 2024 were selected. The patients underwent the urethral tension-free suspension surgery combined with modified vaginal wall repair surgery. The postoperative efficacy was analyzed. Forty-six patients had smooth surgery with minimal intraoperative bleeding. On the first day after surgery, the catheter was removed and urination was smooth. The incision healing was good. The patients were followed-up from 3 to 9 months after surgery. All patients had good urinary control, high sexual satisfaction and improved pelvic organ prolapse and vaginal tightness compared to before surgery. Urethral tension-free suspension surgery combined with modified vaginal wall repair surgery are effective and safe. For patients with mild to moderate bladder prolapse or vaginal laxity，this combined surgery can not only achieve good urinary control, but also improve vaginal relaxation and pelvic floor prolapse at the same time, achieving the purpose of overall repair. It is recommended to be used in female stress urinary incontinence patients with mild to moderate pelvic floor prolapse or vaginal laxity.