Clinical Characteristics of and Preventative Strategies for Peripartum Group A Streptococcal Infections.

OBJECTIVE: To describe clinical characteristics in parturients with group A streptococcal infection and suggest preventive strategies. METHODS: We performed a retrospective review of all group A streptococci cultures from women presenting with peripartum fever or abdominal tenderness between January 2008 and May 2015 in a university hospital. Records and epidemiologic investigations of patients and staff were reviewed. RESULTS: Thirty-seven patients with group A streptococci cultures were identified, with an incidence of one identified postpartum group A streptococcal infection per 2,837 deliveries. Eighty-nine percent of infections occurred postpartum with isolates obtained mainly from the genital tract. Symptoms for group A streptococcal puerperal sepsis were high fever and abdominal tenderness, mostly appearing within 48 hours postpartum. More than one fifth of patients (n=7) developed streptococcal toxic shock syndrome often complicated by multiorgan failure, hysterectomy, and hospitalization in the intensive care unit. There were no uniform risk factors before infection. Epidemiologic investigations suggested that only 23% of infections were nosocomially acquired and that 77% were community-acquired. CONCLUSION: The high morbidity and the scarcity of distinct risk factors related to parturient group A streptococcal infections in the face of often community-acquired group A streptococci call for reassessing preventive strategies. These may include improved microbiological screening during pregnancy in high-prevalence areas or clinical and microbiological risk stratification in the immediate prepartum and peripartum period.

Effects of cancer on ovarian response in controlled ovarian stimulation for fertility preservation.

OBJECTIVE: To evaluate the effects of cancer on ovarian response in controlled ovarian hyperstimulation (COH). DESIGN: Retrospective analysis study. SETTING: University-based tertiary medical center. PATIENT(S): 81 cancer patients undergoing controlled ovarian stimulation cycles for fertility preservation, and age- and date-matched controls undergoing COH for in vitro fertilization (IVF) for male factor infertility. INTERVENTION(S): Controlled ovarian hyperstimulation and oocytes retrieval. MAIN OUTCOME MEASURE(S): Maximal estradiol levels at day of human chorionic gonadotropin administration, duration of stimulation, total amount of gonadotropins administered, number of dominant follicles, number of oocytes retrieved, and rate of metaphase 2 oocytes. RESULT(S): The overall number of dominant follicles and the number of oocytes aspirated of the study group and control were comparable (8.8 ± 5.3 vs. 9.7 ± 4.9, and 11.93 ± 8.3 vs. 12.3 ± 7.9, respectively). The total dose of gonadotropins used and number of stimulation days of the study group (2,250 IU [1,800-3,000 IU] and 9.5 [8-11]) were also similar to the controls (2,100 IU [1,700-2,900] and 10 [9-13]). Comparison between four subgroups of cancer-breast cancer, soft tissue sarcoma, hematologic malignancies, and gastrointestinal tract cancers-showed no difference in their ovarian response indexes. Regression analysis to assess the effect of cancer on ovarian response showed no effect on the main outcome measured. CONCLUSION(S): Cancer does not influence ovarian response in COH for fertility preservation.

Clinical estimation of fetal weight: is accuracy acquired with professional experience?

OBJECTIVE: This study was conducted in order to determine whether experience and type of obstetrical profession improves the accuracy in the clinical estimation of fetal weight among obstetricians and midwives in the delivery room. METHODS: Four groups of professionals in the delivery room clinically estimated the fetal weight in 236 parturients in active labor. Obstetric parameters such as gravidity, parity, gestational age, body mass index, amniotomy, station and cervical dilatation were recorded. Fetal weight estimations were compared with the actual birth weight after delivery. RESULTS: The mean error rate of fetal weight estimation by attending obstetricians, residents, experienced and junior midwives was 7.9 ± 8.8, 8.0 ± 8.4, 7.8 ± 6.3 and 8.5 ± 6.8%, respectively. Error rates of the 4 groups of examiners were similar, although it was increased in all subgroups when estimating birth weights <2,500 and >4,000 g. Major discrepancies of fetal weight estimation (>10% of the actual fetal birth weight) occurred in 27.2, 28.9, 31.9 and 34.7% by attending obstetricians, residents, experienced and junior midwives, respectively. CONCLUSIONS: We found no additional value for experience and type of obstetrical training in the accuracy of clinical fetal weight estimation.

The safety and efficacy of the "inside-out" trans-obturator TVT in elderly versus younger stress-incontinent women: a prospective study of 353 consecutive patients.

OBJECTIVES: To analyze the safety and efficacy of the trans-obturator tension-free vaginal tape (TVT-O) in elderly versus younger stress-incontinent women. METHODS: Ninety-seven consecutive elderly, aged 70 and older, and 256 younger women (mean age 75 and 55 years, respectively) who underwent TVT-O for urodynamically confirmed stress urinary incontinence (SUI) were prospectively enrolled. Concomitant pelvic organ prolapse (POP) repair was performed in 90% of the elderly and 70% of the younger women. The surgical procedures, as well as all pre- and postoperative clinical and urodynamic evaluation, were performed in one university-affiliated medical center. Main outcome measures were operative complications, early and late postoperative morbidity, postoperative urodynamically confirmed SUI (symptomatic, or asymptomatic), persistent, or de novo overactive bladder (OAB) and bladder outlet obstruction (BOO). RESULTS: Mean follow-up of the patients was 30 ± 17 months (range 3-58 months). Early and late postoperative morbidity was similar in both groups, except for significantly more cases of postoperative recurrent UTI's among elderly women (13.7% vs. 6.2%). The incidence of persistent urodynamically confirmed overt SUI was similar in both age groups (5%). However, asymptomatic urodynamic SUI was significantly more common among elderly patients (19% vs. 3.7%, P<0.05). The incidence of persistent OAB was similar in elderly and younger patients (68% and 62%, respectively), while de novo OAB was significantly more common in elderly patients (11.9% vs. 4.7%, P<0.05). CONCLUSIONS: TVT-O is safe and efficient for both elderly and younger stress-incontinent women. However, elderly patients are in increased risk for postoperative recurrent UTI's as well as de novo OAB.

Protracted postpartum urinary retention: the importance of early diagnosis and timely intervention.

AIMS: To evaluate the prevalence and obstetric risk factors of protracted postpartum urinary retention, beyond the third postpartum day. METHODS: Thirty thousand seven hundred fifty-seven consecutive women delivered in Lis maternity hospital during June 2006 to June 2009. The term "protracted postpartum urinary retention" was defined as the absence of adequate voiding beyond the third postpartum day. Study group comprised 55 women who developed protracted postpartum urinary retention. Control group comprised 110 women, matched by age and parity, who delivered at the same day but did not develop urinary retention. RESULTS: Fifty-five (0.18%) women (41 primipara, 14 multipara) developed protracted postpartum urinary retention. On multivariate logistic regression analysis, only duration of the second stage of labor and vacuum deliveries was found to be significant independent risk factors. Thirty-six (65%) women achieved normal voiding within 4-14 days postpartum, and 19 (35%) others within 15-28 days. Higher postvoid residual urinary volume at 72 hr after delivery was associated with increased risk for late recovery. Forty-eight (87%) patients were available for 3-39 months follow-up. Of these, five (10.4%) had stress urinary incontinence, and four (8.3%) had overactive bladder symptoms. Three (6.3%) others had subjective voiding difficulties; however, urodynamic evaluation failed to reveal any voiding phase abnormalities. CONCLUSIONS: Protracted postpartum urinary retention is uncommon in modern obstetric practice. The duration of the second stage of labor and vacuum deliveries were found to be significant independent risk factors. With early diagnosis and timely intervention, complete resolution is expected within 28 days postpartum with no extraordinary long-term consequences.

Intrafollicular and serum levels of leptin during in vitro fertilization cycles: comparison between the effects of recombinant follicle-stimulating hormones and human menopausal gonadotrophin.

OBJECTIVES: To compare the effect of recombinant follicle-stimulating hormones (r-FSH) and human menopausal gonadotrophin (hMG) on leptin levels in serum and follicular fluid (FF) during in vitro fertilization IVF/ET treatment, and to investigate whether leptin levels in the follicular fluid and/or serum are correlated with IVF success. METHODS: Sixty-three patients undergoing IVF cycle were subdivided into two groups. r-FSH was used to for controlled ovarian hyperstimulation in 29 patients (Group A) while, hMG was used in 34 patients (Group B). Our main outcomes were serum and FF leptin on the day of oocyte collection. RESULT(S): The two groups were comparable in age, body mass index (BMI), indications for IVF/ET, E2 level on human chorionic gonadotrophin day, number of retrieved oocytes, fertilization rate, number of transferred embryos and pregnancy rate. Serum and FF leptin levels were similar between the two study groups. Additionally, no correlation was found between levels of leptin in either serum or FF and cycle results such as: number of retrieved oocytes, fertilization rate and pregnancy rate. CONCLUSIONS: r-FSH and hMG have been found to have comparable effects on leptin levels in the serum and the FF of patients undergoing IVF/ET. Additionally, leptin levels in both serum and FF on day of retrieval have no correlation to IVF/ET outcome.

"Inside-out" transobturator tension-free vaginal tape for management of occult stress urinary incontinence in women undergoing pelvic organ prolapse repair.

OBJECTIVES: To assess the safety and effectiveness of the "inside-out" transobturator tension-free vaginal tape procedure for the management of occult stress urinary incontinence (SUI) in clinically continent women undergoing prolapse repair. METHODS: A total of 117 consecutive continent women (mean age and parity 66.8 ± 9.9 years and 3.2 ± 1.5, respectively) with significant pelvic organ prolapse and urodynamically confirmed occult SUI were enrolled in the present study. Surgical intervention included transvaginal prolapse repair and concomitant prophylactic transobturator tension-free vaginal tape. The main outcome measures were procedure-related complications, early and late postoperative morbidity, postoperative urodynamic SUI, persistent or de novo overactive bladder, and bladder outlet obstruction. RESULTS: No cases of significant blood loss, hematoma formation, or bladder injury occurred. Of the 117 patients, 6 (5.1%) had immediate postoperative voiding difficulties necessitating catheterization for >2 days. Late postoperative morbidity was assessed in 110 patients with ≥3 months of follow-up (mean 27.2 ± 17.7). Of these 110 patients, 7 (6.4%) had protracted postoperative thigh pain with spontaneous resolution within 1-3 months, and 7 (6.4%) had developed recurrent urinary tract infections. No cases of vaginal erosion developed. The functional outcome analysis was restricted to 92 patients with ≥12 months of follow-up (mean 31 ± 16). Of the 92 patients, 13 (14%) were found to have urodynamic SUI. However only 2 patients (2.2%) were symptomatic for a subjective and objective cure rate of 97.8% and 86%, respectively. Of the 34 patients who had had overactive bladder preoperatively, 22 (64.7%) had persisting symptoms postoperatively. An additional 4 patients (6.9%) had developed de novo overactive bladder symptoms, and 1 patient had bladder outlet obstruction. CONCLUSIONS: The prophylactic transobturator tension-free vaginal tape procedure is both effective and safe in patients with occult SUI undergoing prolapse repair.

Ovarian stimulation and emergency in vitro fertilization for fertility preservation in cancer patients.

OBJECTIVE: To evaluate the outcome of ovarian stimulation and in vitro fertilization (IVF) in women undergoing fertility preservation prior to chemotherapy compared with healthy patients with infertility due to tubal factor. STUDY DESIGN: Case control, retrospective study in an academic IVF unit. The study participants were 21 cancer patients and 1 patient with focal proliferative glomerulosclerosis, undergoing emergency IVF or intracytoplasmic sperm injection (ICSI; Group A) and 22 patients undergoing IVF for tubal factor (Group B). All patients underwent controlled ovarian stimulation, ovum pick-up, and embryo freezing or transfer. The outcome measures included: dose of gonadotropins, mean estradiol and progesterone levels, length of stimulation, number of retrieved oocytes, number of 2 pronuclei zygotes, fertilization rate, and clinical pregnancy rate. Student's t-test was used for assessment of group comparisons. RESULTS: Patients in Group A (mean age 32.8+/-5.7 years) underwent 22 emergency IVF cycles for fertility preservation prior to chemotherapy. The mean number of days until human chorionic gonadotropin administration was 10.4+/-4.8. Eleven cycles involved normal insemination while nine involved ICSI. In one cycle three arrested immature oocytes were retrieved, and in one cycle no oocytes were retrieved. Donor sperm was used in 9 cycles. Tamoxifen was part of the treatment protocol in 6 IVF cycles of breast cancer patients. The mean age of the women in Group B was 34+/-4.2 years. There were no significant differences in any of the main outcome measures between the two groups. Thawed embryos were transferred in four cancer patients: two patients had colon cancer, one had breast cancer and one had pseudomyxoma peritonei. Two of these four women conceived and gave birth to healthy newborns. CONCLUSIONS: Emergency IVF is a promising approach for preserving fertility in cancer patients. Current treatment protocols offer a minimal time delay until chemotherapy is commenced, and the ovarian stimulation outcomes are comparable to those of women with tubal factor.

Bladder perforation during tension-free vaginal tape surgery: does it matter?

OBJECTIVE: To analyze the incidence, possible risk factors, preoperative morbidity and outcome results in tension-free vaginal tape (TVT) cases complicated by lower urinary tract injury in a large, heterogeneous, consecutive group of women. STUDY DESIGN: Four hundred sixty consecutive women who underwent TVT surgery for correction of urodynamically proven stress urinary incontinence were enrolled prospectively. All the procedures were performed at 1 center by 3 experienced surgeons. RESULTS: In this series, 3.9% cases of lower urinary tract injury occurred. Most of the injuries occurred during the learning curve. TVT-related urinary tract injury was not associated with increased perioperative morbidity. The cure rates were similar with and without injury. De novo urge and persistent urge incontinence were slightly more common in patients with bladder perforation. CONCLUSION: Lower urinary tract injury during the TVT procedure is directly related to the inexperience of the surgeon. However, TVT-related lower urinary tract injury does not appear to affect medium-term outcome results.

First vaginal delivery at an older age: Does it carry an extra risk for the development of stress urinary incontinence?

AIMS: First delivery at an older age is not an uncommon event in modern obstetric practice. The present study was undertaken to compare the prevalence of postpartum stress urinary incontinence (SUI) according to maternal age and mode of delivery. METHODS: Fifty two consecutive elderly primiparae (mean age 40.0 +/- 1.8) who underwent spontaneous vaginal delivery, 42 consecutive elderly primiparae (mean age 40.7 +/- 3.6) who underwent elective cesarean section, and 92 consecutive young primiparae (mean age 26.2 +/- 2.5) who underwent spontaneous vaginal delivery were interviewed 1-2 years postpartum about the symptom of SUI. Women who had SUI before pregnancy were not enrolled. Obstetric data were collected from computerized hospital records. RESULTS: The prevalence of SUI 1-2 years after spontaneous vaginal delivery was significantly higher in elderly compared with younger primiparae (38.5% vs. 9.8%, respectively). Elderly primiparae who underwent elective cesarean section had a significantly lower prevalence of postpartum SUI than those delivered vaginally (16.7% vs. 38.5%, respectively). Further comparison of stress-incontinent versus continent elderly primiparae failed to reveal significant demographic or obstetric differences, except for increased prevalence of SUI during pregnancy among incontinent patients (45% vs. 19%, respectively). CONCLUSIONS: First vaginal delivery at an older age carries an increased risk for postpartum SUI. Stress-incontinent women also had higher prevalence of SUI during pregnancy. This finding implies that the pathophysiologic process of SUI begins during pregnancy, prior to active labor and delivery. Nonetheless, elective cesarean section in these women has a protective effect and lowers the risk of developing postpartum SUI.

[The male's role in the etiology of preeclampsia].

Preeclampsia is a major cause of morbidity and mortality in mothers, fetuses, and neonates worldwide, with 5%-10% of human births being affected. The cause is still uncertain, and many controversies exist concerning its management. Preeclampsia-eclampsia is due to the failure of extra-villous cytotrophoblast to invade the maternal uterine spiral arteries to a sufficient depth, inducing poor vascular exchanges between the mother and the placenta. This physiological endovascular trophoblast invasion represents a remarkable immunological placental-maternal interaction. Recent data strongly indicate an important role for the male partner in the causation of this common pregnancy disorder. This review aims to discuss the relevant literature and to explain how paternal, relational and sexual factors play an important role in the etiology of preeclampsia.

Erythrocyte aggregation is increased in preterm premature rupture of the membranes.

OBJECTIVE: To asses the degree of erythrocyte aggregation in the peripheral blood of women with preterm premature rupture of the membranes (PPROM). STUDY DESIGN: This was a prospective case control study. Twenty patients with preterm premature rupture of the membranes and matched controls were recruited at the Lis Maternity Hospital. A slide test and image analysis were used to quantitate the degree of erythrocyte aggregation. Hematological indices and markers of inflammation such as the erythrocyte sedimentation rate and C-reactive protein were also compared. RESULTS: The vacuum radius (VR) of the study group was significantly higher than in the control group at 14.8+/-1.6 microm versus 10.0+/-1.0 microm, respectively (P=0.03). Other hematological indices were not changed significantly between the groups. CONCLUSIONS: We found an increase in erythrocyte aggregation in the peripheral blood of patients with preterm premature rupture of the membranes. We used this sensitive marker of inflammation to further support the theory that PPROM is an inflammatory state.

Chorioamnionitis associated with Crohn's disease and azathioprine treatment: a case report.

This paper reports a case of S. constellatus chorioamnionitis in a pregnant Crohn's disease patient who was taking azathioprine. Chorioamnionitis is a major cause of perinatal morbidity. Azathioprine, an immunosuppressive antimetabolite, is widely used to treat inflammatory bowel disease. Streptococcus constellatus is a Gram-positive bacterium that has not previously been associated with chorioamnionitis. A high index of suspicion for chorioamnionitis and unusual pathogens should be maintained in the management of obstetric patients on immunosuppressive agents.

Enhanced erythrocyte aggregation in clinically diagnosed pelvic inflammatory disease.

OBJECTIVE: Enhanced erythrocyte aggregation, revealed using a simple bedside test, has been found recently in several inflammatory conditions. The diagnosis of pelvic inflammatory disease (PID) is at times difficult because of the vague symptoms and signs, but is crucial because even mild PID can have future reproductive consequences. Our objective was to determine the degree of erythrocyte aggregation in PID. The demonstration of an increase in aggregation could be of additive value in cases in which the diagnosis is difficult. STUDY DESIGN: A prospective case-control study was conducted. Fifteen consecutive women diagnosed clinically as having PID based on Centers for Disease Control and Prevention criteria, and 15 matched controls were enrolled. Blood samples were drawn for hematologic indices, C-reactive protein, fibrinogen levels, and red cell aggregation. We studied the degree of red cell aggregation using a simple slide test and image analysis. The variable measured was the erythrocyte percent (EP), equivalent to the slide area covered by erythrocytes. RESULTS: Erythrocyte percent was 59.6 +/- 4.2 and 80.0 +/- 3.6 for the study group and controls, respectively (P <0.001). A significant difference was noted also for the other hematologic and biochemical markers of inflammation between patients and the controls. CONCLUSIONS: We conclude that the degree of erythrocyte aggregation is increased in PID. Its simplicity, rapidity, and low cost should be further evaluated as a diagnostic tool in the context of this frequent disease.

Elevated levels of CRP in ovarian hyperstimulation syndrome: an unrecognised potential hazard?

OBJECTIVE: Elevated levels of C-reactive protein (CRP) were found recently to be a crucial marker for cardiovascular disease. This protein might have a role in endothelial cell activation, vascular damage and a thrombotic tendency. We sought to determine whether concentrations of CRP are altered in women with controlled ovarian hyperstimulation (COH) or hyperstimulation syndrome (OHSS). DESIGN: A prospective cohort study. SETTING: The gynecology department and IVF unit of the Lis maternity hospital. POPULATION: Twenty women with OHSS, 20 women undergoing COH and 20 women who participated as controls were included in the study. METHODS: Venous blood was withdrawn for analysis of high sensitive C-reactive protein (hs-CRP) using the Boering BN-II nephelometer. MAIN OUTCOME MEASURES: hs-CRP levels were determined. RESULTS: There was a significant (P < 0.05) difference in the hs-CRP concentrations in women with OHSS compared with women with COH and controls. The respective values for hs-CRP were 19.0 [4.0], 7.0 [1.7] and 4.6 [1.1] mg/L. CONCLUSIONS: Women with OHSS have elevated concentrations of hs-CRP. This finding, previously believed to merely represent an acute phase response, may actually represent a yet unrecognised pathophysiological factor of this syndrome and pave the way for new investigational directions of this potentially hazardous condition.

Tension-free vaginal tape in the elderly: is it a safe procedure?

OBJECTIVES: To analyze the safety and efficacy of tension-free vaginal tape (TVT) surgery in elderly versus younger women with stress urinary incontinence (SUI). METHODS: A total of 157 consecutive elderly women, aged 70 years and older, and 303 younger women (mean age, 74.8 and 57.2 years, respectively) who underwent TVT for urodynamically-confirmed SUI were prospectively enrolled. Concomitant genitourinary prolapse repair was performed in 84% of the elderly and 67% of the younger women. The main outcome measures were perioperative morbidity, postoperative SUI, persistent or de novo urge incontinence, and voiding dysfunction. RESULTS: The incidence of TVT-related morbidity was similar in both groups, except for significantly fewer cases of bladder perforation among elderly women (1.3% versus 4.9%, P <0.05). However, some age-related morbidity was noted among the elderly women: 2 cases of pulmonary embolism, 2 cases of cardiac arrhythmia, 1 case of severe pneumonia, and 1 case of deep vein thrombosis. The outcome analysis was restricted to 123 elderly and 208 younger women with follow-up of at least 12 months (mean, 30 +/- 12 months; range, 12 to 67 months). The incidence of persistent postoperative SUI and persistent urge incontinence was similar in both age groups. However, de novo urge incontinence was significantly more common among elderly women (18% versus 4%, P <0.05). Two elderly and three younger women had postoperative pressure-flow studies suggestive of bladder outlet obstruction. CONCLUSIONS: Tension-free vaginal tape surgery in elderly women is associated with good outcome results; however, the risk of postoperative de novo urge incontinence, as well as age-related morbidity, is increased.

The contribution of laminaria placement for cervical ripening in second trimester termination of pregnancy induced by intra-amniotic injection of prostaglandin F(2)alpha followed by concentrated oxytocin infusion.

OBJECTIVE: Our purpose was to determine whether intracervical placement of laminaria stalks would improve the effectiveness of inducing termination of pregnancies in the second trimester by intra-amniotic injection of prostaglandin F(2)alpha. STUDY DESIGN: This is a prospective randomized clinical trial conducted at Gynecology Department, Lis Maternity Hospital. Fifty women admitted for indicated second trimester pregnancy termination were randomly assigned to receive either intracervical placement of laminaria (n = 25) or not (n = 25), with concurrent use of intra-amniotic injection of prostaglandin F(2)alpha and concentrated oxytocin. The outcome measures were: time from induction to delivery and the side effects and complications of treatment. RESULTS: There was no significant difference in the mean interval from induction to delivery in the laminaria and no laminaria groups, being 20 +/- 1.3 (8-30) h versus 19 +/- 1.0 (8-26) h, respectively. In addition, this interval was not different in subgroups of primiparas or multiparas. Other outcome measures such as retained placenta (4% in both groups), post-partum hemorrhage (4% in both groups) gastro-intestinal side effects, fever, and use of analgesia were not significantly different between both groups. CONCLUSION: We found no additional value in placing laminaria stalks when using intra-amniotic injection of prostaglandin F(2)alpha followed by concentrated oxytocin infusion for second trimester termination of pregnancy.

Trophoblastic tissue spread to the sigmoid colon after uterine perforation.

BACKGROUND: Trophoblastic tissue spread following uterine perforation during dilation and curettage is rare. We present a case of trophoblastic spread to the sigmoid colon following uterine perforation, which was treated by surgical removal of the implants and intramuscular administration of methotrexate. CASE: A woman presented 3 weeks after curettage for a blighted ovum. Laparotomy performed for suspected intra-abdominal bleeding revealed bleeding trophoblastic implants in a perforation tract and the anterior uterine wall and on the appendix epiploica of the sigmoid colon. The implants were surgically removed and methotrexate was administered for persistently high beta-hCG levels. The patient fully recovered. CONCLUSION: Extrauterine trophoblastic implants should be considered in women evaluated for abdominal pain whose pregnancy test is positive after uterine perforation. Conservative treatment with methotrexate in nonacute patients may be considered.

Tension-free vaginal tape (TVT) for the treatment of occult stress urinary incontinence in women undergoing prolapse repair: a prospective study of 100 consecutive cases.

AIMS: Clinically continent women with genitourinary prolapse and occult stress urinary incontinence (SUI) are considered to be at high risk of developing symptomatic SUI once the prolapse is repaired. We studied the efficacy and safety of tension-free vaginal tape (TVT) procedure in preventing postoperative SUI in these women. METHODS: One hundred consecutive women (mean age 66.7 +/- 9.9 years) with significant genitourinary prolapse and occult SUI were prospectively enrolled. Preoperatively, none of the women complained of SUI. However, all had urodynamically-confirmed occult SUI, revealed by repositioning of the prolapse. Surgical intervention was comprised of transvaginal prolapse repair and prophylactic TVT procedure. Main outcome end points included operative morbidity, postoperative SUI, persistent or de novo urge incontinence, and voiding dysfunction. RESULTS: The mean follow-up period was 27 months (range: 12-52 months). There was only one case of technique-related bladder perforation with no adverse outcome. Two other patients had postoperative urinary retention necessitating catheterization for more than 7 days, none of whom required any surgical intervention. Vaginal erosion of the tape was diagnosed in three patients, all of whom were successfully treated by excision of the eroded tape. Two (2%) patients developed urodynamically-confirmed SUI within 1 year postoperatively. However, postoperative urodynamics revealed asymptomatic sphincteric incontinence in 15 (15%) other patients. Thirteen (72%) of 18 patients with preoperative urge incontinence had postoperative persistent urge incontinence. De novo urge incontinence developed postoperatively in 8 (8%) patients. CONCLUSIONS: TVT procedure is effective and safe in patients with occult SUI undergoing prolapse repair. Long-term durability of this procedure is yet to be established.