336 NJ, USA), which was introduced in 2005, attempts to lower the number of complications by involving only a small vagi- nal incision and no exit wound. 　As recently reported, the short-term results of the TVT-S procedure seem to be similar to those of the conventional ‘outside-in’ technique of the transobturator route for sub- urethral tape placement, i.e., the transobturator tape (TOT) procedure. However, results of efficacy and satisfaction with TVT-S are lacking in patients with long-term follow- up [4]. Therefore, we evaluated the long-term results of the TVT-S procedure in women with SUI. MATERIALS AND METHODS This study was conducted in the urology division at our na- tional university hospital between March 2008 and Feb- ruary 2009. During this period, the TVT-S procedure was performed for all patients with clinical and urodynamic di- agnoses of SUI who needed anti-incontinence surgery. Patients who had urinary tract infection, urogynecological malignancy, or neurogenic bladder were excluded from the study. The population consisted of 51 women who under- went the TVT-S procedure. The surgery was done under general or spinal anesthesia by one experienced surgeon. The surgical approach of the TVT-S procedure was through the U approach. The patients included in the study had SUI or stress-predominant mixed urinary incontinence proven by urodynamic study. Preoperative evaluation included a history, cough stress test with full bladder, urodynamic study, and incontinence quality of life (I-QoL) question- naire. All subjects underwent a pelvic examination in the seated semilithotomy position with a Valsalva maneuver. The pelvic organ prolapse quantification (POP-Q) stand- ard scoring system was adopted for staging. Because the degree of POP was minimal, surgical management for pel- vic organ prolapse was not performed. Following the post- operative period, urinary incontinence status was exam- ined through a physical examination, and the I-QoL ques- tionnaire was completed in an outpatient setting or by telephone. 　Cure was defined as the absence of any episodes of in- voluntary urine leakage during stressful activities and a stress test. Improvement was defined as a significant re- duction in urine leakage, such that it did not require further treatment. 　Statistical analysis of the data was performed by using Student’s t-test. SPSS ver. 17.0 (SPSS Inc., Chicago, IL, Shin et al USA) was used for the data analysis. Statistical signifi- cance was set at p＜0.05. RESULTS The population included 46 patients. Five patients were ex- cluded because of loss to follow-up. The mean age of the pop- ulation was 57.89 years (range, 38-85 years), mean parity was 3.07 (range, 1-6), mean body mass index was 25.54 kg/m2 (range, 21-35 kg/m2), and mean symptom duration was 5.09 years (range, 1-15 years). The mean follow-up pe- riod was 25.16 months (range, 24-34 months). Urge urinary incontinence was present in 5 patients (10.8%). Stamey symptom grade 1 was present in 27 patients (58.6%) and grade 2 was present in 19 patients (41.4%). POP was pres- ent in 17 patients (36.9%), and 2 patients (4.3%) had under- gone a previous anti-incontinence surgery. The mean max- imum flow rate was 26.32 ml/s (range, 10-48 ml/s), and mean postvoid residual volume was 17.53 ml/s (range, 10-70 ml/s). Mean Valsalva leak point pressure was 85.16 cmH2O (range, 50-95 cmH2O), and mean maximum ure- thral closure pressure was 52.53 cmH2O (range, 13-74 cmH2O) (Table 1). TABLE 1. Clinical characteristics of the patients treated with the TVT-S Variables Mean age (yr) Mean parity (range) Mean BMI (kg/m2) Mean symptom duration (yr) Mean follow-up (mo) No. with presence of urge urinary incontinence (%) No. Stamey symptom grade No. with presence of POP (%) No. with history of previous anti- incontinence surgery (%) Mean maximum flow rate (ml/s) Mean postvoid residual volume (ml) Mean VLPP (cmH2O) Mean MUCP (cmH2O) I (%) II (%) Values 57.89 (41-77) 3.07 (1-6) 25.54 (21-35) 5.09 (1-15) 25.16 (24-34) 5 (10.8) 27 (58.6) 19 (41.4) 17 (36.9) 2 (4.3) 26.32 (10-48) 17.53 (10-70) 85.16 (50-95) 52.53 (13-74) TVT-S: tension-free vaginal tape-Secur, BMI: body mass index, POP: pelvic organ prolapse, VLPP: Valsalva leak point pressure, MUCP: maximum urethral closure pressure TABLE 2. Comparison of preoperative and postoperative I-QoL scores I-QoL Subscales Total Avoidance and limiting behaviors Psychosocial impacts Social embarrassment Baseline 35.44 36.80 39.61 25.78 1 month 77.31 76.94 79.89 73.28 2 years 67.57 73.52 65.35 71.23 I-QoL: incontinence quality of life, a: comparison of baseline vs 1 month, b: comparison of baseline vs. 2 years Korean J Urol 2011;52:335-339 p-valuea ＜0.026 ＜0.034 ＜0.045 ＜0.001 p-valueb ＜0.013 ＜0.021 ＜0.046 ＜0.023