2-Year Outcomes of TVT-Secur TABLE 3. Surgical outcomes of TVT-S Success 　Cure (%) 　Improvement (%) Failure (%) TVT-S: tension-free vaginal tape-Secur 1 month 80.4 (37/46) 13.1 (6/46) 6.5 (3/46) 2 years 76.0 (35/46) 10.8 (5/46) 13.2 (6/46) TABLE 4. Results of urodynamic study in the cure or improvement group compared with the failure group Cure or improvement group (n=40) 26.43 15.32 87.27 52.64 Failure group (n=6) 25.58 32.26 71.09 51.79 Mean maximum flow rate (ml/s) Mean postvoid residual volume (ml) Mean VLPP (cmH2O) Mean MUCP (cmH2O) VLPP: Valsalva leak point pressure, MUCP: maximum urethral closure pressure 　The preoperative mean total I-QoL score was 35.44. One month after the operation, the mean total I-QoL score was 77.31 (Table 2). Two years after the operation, the mean total I-QoL score was 67.57. Mean total I-QoL scores in- creased 42 points at 1 month and 32 points at 2 years after TVT-S (p＜0.026, p＜0.013) (Table 2). Most patients re- ported significant improvements in quality of life. 　The overall cure rate was 80.4% at 1 month after TVT-S and 76.0% at 2 years after TVT-S. The overall cure or im- provement rate was 93.5% at 1 month and 86.8% at 2 years after TVT-S. The failure rate was 6.5% at 1 month and 13.2% at 2 years after TVT-S (Table 3). 　Results of urodynamic study in the cure or improvement group compared with the failure group were obtained. In the cure or improvement group, mean maximum flow rate, mean Valsalva leak point pressure, and mean maximum urethral closure pressure were higher than in the failure group. Mean postvoid residual volume was lower in the cure or improvement group (Table 4). The statistical sig- nificance of these differences could not be determined, how- ever, because of the limited number in the failure group. 　Three patients (6.5%) had urinary retention after sur- gery, which was managed with temporary clean inter- mittent catheterization. De novo urgency developed in 4 patients (8.6%). Among 5 patients who had urge urinary incontinence before the operation, 2 patients had persis- tent urge urinary incontinence. No vaginal or urethral ero- sion was identified. At the 2-y follow-up, there were no sig- nificant complications related to TVT-S. DISCUSSION Before 1996, SUI was optimally treated with one of several forms of retropubic colposuspension, the pubovaginal sling, 337 injectable bulking agents, or needle suspension [2]. Although associated with acceptable “cured/dry” rates, each of these procedures is subject to inherent complications, is cumber- some to perform or difficult to learn, or is associated with unacceptable morbidity [5-7]. The TVT, whose design was determined from the integral theory’s focus on midurethral continence, offered a less-invasive, outpatient-based treat- ment option for SUI [3]. However, the TVT procedure has been associated with specific risks, including bladder, bow- el, and vascular injury, owing to the blind passage of the trocars through the retropubic space [8]. In response to these risks, the TVT procedure was modified, and the TOT procedure was introduced in 2001 [9]. Instead of trans- gressing the retropubic space, the TOT procedure passes the trocars blindly through the obturator foramen in an “inside-out” or “outside-in” fashion that thus obviates the risk of injury to the retropubic organs. Although promising, the TOT procedure has been associated with a small, but defined, risk of prolonged leg pain, ostensibly owing to pas- sage of the transvaginal mesh through the obturator fora- men proper [10]. The conventional TOT approach has re- solved some of these problems by passing the obturator fos- sa to avoid getting in the retropubic space, so that the tape is far enough away from the bladder, vessels, and bowel [11]. However, even this revolutionary approach is asso- ciated with some complications, such as thigh pain, hema- toma due to significant intraoperative bleeding, and post- operative bladder outlet obstruction [12]. 　TVT-S was planned to reduce the invasiveness of the tape procedure by developing a new tape. The principal idea of this novel technique was to introduce a midurethral sling from a single incision without passing the retropubic space or the obturator foramen and its related nerves and vessels [13]. The TVT-S procedure utilizes a shorter sling (8 cm) that is anchored directly to the retropubic fascia (U method) or the obturator internus muscle (H method). These steps lead to less dissection, lower amounts of syn- thetic material, and possibly fewer complications. Exit points are unnecessary, which reduces the immediate and persistent pain. 　Gagnon and Tu reported that improvement in incon- tinence symptoms was much higher with the U Method than with the Hammock technique [14]. The success rate increased with time, reaching a statistically significant dif- ference at 6 months with 100% (22/22) improvement com- pared with 69% (11/16) for the Hammock technique. The U Method seems to offer better support to the urethra and a stronger fixation of the mesh. The tightness applied to the tape during the surgery is also important for obtaining good results [14]. Accordingly, the surgical approach of the TVT-S procedure was through the U approach in our study. 　A small number of published articles are available on the TVT-S. Reported success rates for the TVT-S are about 80% [14]. To our knowledge, the first report came from Martan et al in January 2007 [15]. At 1 to 3 months of follow-up, they reported a cure rate of 93% in 15 patients, 10 with the Hammock technique. In 2008, Debodinance et al published Korean J Urol 2011;52:335-339