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TRANSRECTAL HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU) USING THE SONABLATE®500 FOR THE TREATMENT OF PROSTATE CANCER; THE PERUGIA-TURIN EXPERIENCE
197
198
ANALYSIS OF PROSTATE TUMOUR ANGIOGENESIS AS A PREDICTOR OF TREATMENT RESPONSE TO HIGH INTENSITY FOCUSED ULTRASOUND
TRANSRECTAL HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU) USING THE SONABLATE®500 FOR THE TREATMENT OF PROSTATE CANCER; THE PERUGIA-TURIN EXPERIENCE
Colombel M.1, Mege Lechevallier F.2, Ricci E.1, Chapelon J.Y., Gelet A.1, Martin X.1
1
1 Hospices Civils de Lyon, Dept. of Urology, Lyon, France, 2Hospices Civils de Lyon, Dept. of Pathology, Lyon, France, Hospices Civils de Lyon, Inserm, Lyon, France
Introduction & Objectives: Prostate tumor vascular density and factors that FRQWULEXWH WR WKH H[WHQW RI WXPRU DQJLRJHQHVLV PD\ LPSDFW RQ WKH HᚑFDF\ RI hyperthermia based therapies. Here we explored the relationship between the extent of prostate tumor angiogenesis and the response to HIFU. Material & Methods: Inclusion criteria: primary localized prostate cancer (T1736$OHVVWKDQ*OHDVRQRUOHVV WUHDWHGE\+,)8DQG785 SURVWDWH tumor angiogenesis evaluation by measurement of the expression of VEGF, &' 9(17$1$p DXWRPDWH HW TXDQWLᚏFDWLRQ RI WKH PLFURYHVVHO VXUIDFH DUHDXVLQJWKH3,;,7V\VWHP 1,.21p SULPDU\REMHFWLYHZDVWRHYDOXDWHWKH association between the expression level of the markers and the extent of tumor microvessel density and the response to treatment as assessed by post HIFU SURVWDWHELRSVLHVDWPRQWKV
Mearini L.1, D’urso L.2, Collura D.2, Zucchi A.1, Formiconi A.2, Muto M.2, Porena M.1 University of Perugia, Dept. of Urology, Perugia, Italy, 2Ospedale San Giovanni Bosco, Dept. of Urology, Turin, Italy Introduction & Objectives: High Intensity Focused Ultrasound (HIFU) is a relatively novel, minimally invasive therapy for prostate cancer. Data from other centres indicate that the early RQFRORJLFDO HᚑFDF\ LV SURPLVLQJ DQG WKDW LW DSSHDUV WR EH ZHOO WROHUDWHG DQG DVVRFLDWHG ZLWK D IDYRXUDEOH VLGH HᚎHFW SURᚏOH 7KLV VWXG\ LV D SUHOLPLQDU\ UHSRUW RQ RQFRORJLFDO RXWFRPHV RI patients treated with Sonablate®500 HIFU device in our centre. Material & Methods: %HWZHHQDQGPHQZLWK7710KLVWRORJLFDOO\SURYHQ adenocarcinoma of the prostate underwent transrectal HIFU in a Day Surgery setting. All patients gave informed consent, had HIFU under general or regional anaesthesia and were discharged with either a urethral or suprapubic catheter for at least 14 days. Follow up to determine RQFRORJLFDORXWFRPHLQFOXGHG 36$VDPSOHVDWPRQWKDQGWKHQHYHU\PRQWKVDIWHUWUHDWPHQW DQGDSURVWDWHELRSV\LQDOOSDWLHQWVDWPRQWKV)DLOXUHZDVGHᚏQHDFFRUGLQJWR SRVLWLYHᚏQGLQJV at follow up biopsy and/or biochemical failure (according to American Society for Therapeutic Radiology and Oncology ASTRO criteria).
Results: $WRWDORIFRQVHFXWLYHSDWLHQWV s\R ZHUHLQFOXGHGDPRQJ WKHP UHVSRQGHUV QHJDWLYH ELRSVLHV DQG ZLWK UHVLGXDO FDQFHU SRVLWLYH biopsies). Results showed a strong association between the level of local tumor angiogenesis and the mean surface area of microvessels and response to WUHDWPHQW $129$&'H[SUHVVLRQ S $129$PHDQVXUIDFHDUHD S 0.006). On the contrary there was no association between the expression level of VEGF and treatment response
Results: 0HGLDQDJHZDV\UV 6' PHGLDQEDVHOLQH36$YDOXHZDVQJPO 6' *OHDVRQ VFRUH UDQJHG VWDJH RI GLVHDVH ZDV 7 LQ SWV 7 LQ SWV DQG 7D LQ SDWLHQWV0HGLDQSURVWDWHYROXPHZDVPO 6' 0HGLDQWUHDWPHQWWLPHZDV PLQXWHV 6' 0HGLDQIROORZXSZDVPRQWKV 6' $IWHU+,)8WUHDWPHQW36$GURSSHGWRD median nadir value of 0.18 ng/ml (SD 1.9). The median PSA value at three and six months were QJPO 6' DQGQJPO 6' UHVSHFWLYHO\$WPRQWKVSHUFHQWDJHRIQHJDWLYH ELRSV\ZDVSDWLHQWVZHUHUHWUHDWHGZLWK+,)8ZKLOHWKHRWKHUVZLWK(%57RUKRUPRQH therapy. According to ASTRO criteria, there was bio chemically no evidence of disease (bNED) LQ RYHUDOO5LVNVWUDWLᚏFDWLRQXVLQJWKH'ಬ$PLFRFULWHULDVKRZWKDWMXVWFRQVLGHULQJWKHORZ and intermediate risk group, the bNED is 87.2%. At univariate analysis, a negative biopsy at 6 months and bNED was statistically associated with a lower baseline PSA values and lower PSA nadirs at 1 month, T1-T2 stage and a lower Gleason score. At multivariate analysis, only baseline PSA is an independent predictor of a positive biopsy, while only clinical stage is an independent predictor of bNED.
Conclusions: This study suggest as expected that the physical action of HIFU is not dependent on the tumor grade but rather on the tissue properties (tumor and stroma). The local angiogenesis might limit the action of hyperthermia et may explain the synergic action of anti angiogenic drugs as observed in animal models
Conclusions: We have demonstrated promising early oncological outcomes using the Sonablate®500 for the treatment of prostate cancer. These data are in line with other European centres which attest to the reproducibility of the treatment regimen. We have found that outcome is positively associated with a lower baseline PSA, lower PSA nadir, lower Gleason score and lower tumour stage. As with any novel technology, long term data will be required before this technique gains widespread clinical acceptance outside of specialist centres.
199 RESIDUAL PROSTATE CANCER AFTER A FIRST HIFU SESSION: ONCOLOGICAL BENEFITS OF A SECOND SESSION Murat F.J.1, Poissonnier L.1, Pricaz E.1, Rouviere O.2, Chapelon J.Y., Colombel M.1, Gelet A.1
P12 TAPES FOR URINARY INCONTINENCE Wednesday, 26 March, 14.30-16.00, Blue Hall 1
200
PRE AND INTRA-OPERATIVE PREDICTIVE FACTORS OF OCCULT STRESS INCONTINENCE IN PATIENTS WITH A SYMPTOMATIC PROLAPSE FOR APPLICABILITY OF SLING OPERATIONS Farahat Y.1, Awara A.2
1 Edouard Herriot Hospital, Dept. of Urology, Lyon, France, 2Edouard Herriot Hospital, Dept. of Radiology, Lyon, France, INSERM, Unit 556, Lyon, France
1
Introduction & Objectives: HIFU repeatability is, with its minimally invasiveness, one of the major advantages of this technique for the treatment of localized prostate FDQFHU /3&D :HHYDOXDWHGWKHRQFRORJLFDOHᚑFDF\RIDVHFRQG+,)8VHVVLRQIRU residual LPCa.
Introduction & Objectives: For patients with prolapse and occult stress incontinence (OSI), we tried to apply some predictive factors before prolapse repair and intraoperative after the repair to identify patients who were really in need for sling operation to avoid unnecessary procedure.
Material & Methods: Between 01/2000 and 05/2005, 227 patients, mean age 69.9, UHFHLYHG+,)8VHVVLRQVDPRQJWKHZKRUHFHLYHG+,)8IRU/3&DZLWKWKHᚏUVW JHQHUDWLRQ+,)8GHYLFH+,)8ZHUHGHOLYHUHGXQGHUVSLQDODQHVWKHVLDXVLQJWKHᚏUVW generation of Ablatherm HIFU device. Low and intermediate risk patients were 79 DQGUHVSHFWLYHO\ZLWKDPHDQ36$DQGSURVWDWHYROXPHRIQJPODQGFF respectively on initial evaluation. Follow-up included serial PSA measurements every PRQWKVV\VWHPDWLFFRQWUROELRSVLHVPRQWKVSRVW+,)8DQGDGGLWLRQDOELRSVLHVLQ FDVHRIULVLQJ36$7KH3KHQL[FULWHULDIRUVDOYDJHWUHDWPHQWZHUHXVHGWRGHᚏQHWKH disease-free survival rate (DFSR).
Material & Methods: 145 female patients with prolapse without associated urinary complaint who are undergoing surgical repair of pelvic organ prolapse were subjected preoperatively to repositioning of their prolapse using pessary and then subjected to pad test and urodynamic studies to evaluate for occult SI. Occult stress incontinence ZDVGHᚏQHGDVDSRVLWLYHVWUHVVWHVWZLWKUHSRVLWLRQLQJRIWKHSURODSVH2QO\SDWLHQWV ZKRKDG26,DIWHUUHSRVLRQLQJRIWKHLUSURODSVH ZHUHHQUROOHGLQWKHVWXG\$OOWKH patients underwent prolapse repair and then re-evaluated intraoperatively by stress test. All the patients demonstrated intraoperative +ve stress tests -after the repair- underwent 797DQGZHUHH[FOXGHGIURPWKHVWXG\ SDWLHQWV :KLOHದYHVWUHVVWHVWSDWLHQWV patients) were divided randomly into 2 groups: group I: 15 patients underwent sub urethral sling (TVT) group II: 15 patients without additional anti incontinence procedure. Both groups were evaluated both subjectively and objectively by urodynamic studies at DQGPRQWKVSRVWRSHUDWLYHO\
Results: Retreatment was decided because of positive biopsy during systematic control (58%) or PSA rise (42%) with a mean delay of 16.6 months between 2 sessions. The pre-HIFU retreatment PSA and prostate volume were 2.1 +/-2.2 and 9.5 +/-5 cc, respectively. 17% only had a Gleason sum superior to the initial Gleason including 4% of Gleason equal or superior to 8. Prostate recurrence was equally GLVWULEXWHGLQWKHSURVWDWH DSH[PLGEDVH 0HDQSRVWQG+,)8 follow-up was 25 months. Mean post-2nd HIFU PSA nadir and prostate volume were 0.66 +/- 1.44 ng/ml and 7 +/- 6.7 cc, respectively. Control biopsies were negative in RIWKHSDWLHQWVZKRDFFHSWHGV\VWHPDWLFFRQWURO$FWXDULDO\HDUVSHFLᚏF VXUYLYDO ZDV $FWXDULDO \HDU ')65 ZDV ZLWK VLJQLᚏFDQW GLᚎHUHQFH between low and intermediate risk patients, 67% and 46%, respectively (p=0.05). Conclusions: +DOIRIWKHSDWLHQWVZLWKUHVLGXDO/3FDDIWHUDᚏUVW+,)8VHVVLRQZLOOEH GLVHDVHIUHHDW\HDUVIROORZLQJDVHFRQG+,)8SURFHGXUH+,)8RᚎHUVWKHXQLTXH opportunity to be repeated with no limited doses conversely to radiation.
Eur Urol Suppl 2008;7(3):120
Tanta University, Dept. of Urology, Tanta, Egypt, Gynaecology and Obstetric, Tanta, Egypt
2
Tanta University, Dept. of
Results: ,QJURXS, SDWLHQWVZLWK797 QRFOLQLFDOO\GHWHFWHG6,LQDOOSDWLHQWVDWDQG PRQWKVIROORZXSEXWRXWRISDWLHQWVKDGXURG\QDPLFDOO\6,ZKLFKQRWDᚎHFWLQJ her QoL and no extra maneuver was required. 2 patients in this group developed lower urinary obstructive symptoms and were catheterized for extra 10 days post operatively. in group II (15 patients without TVT) 1 out of 15 patients had clinically detected SI at PRQWKV IROORZ XS DQG 797 ZDV SHUIRUPHG DW PRQWKV LQ DGGLWLRQ SDWLHQWV KDG XURG\QDPLFDOO\6,ZKLFKQRWDᚎHFWLQJWKHLU4R/DQGQRH[WUDPDQHXYHUZDVUHTXLUHG Conclusions: Routine use of sling with prolapse repair as a prophylactic procedure for occult SI is not recommended. Preoperative evaluation of occult SI is not usually accurate, therefore combined preoperative and intraoperative testing is useful to identify women with prolapse who are really in need for sling operation after prolapse repair to avoid unnecessary sling procedures.
198
ANALYSIS OF PROSTATE TUMOUR ANGIOGENESIS AS A PREDICTOR OF TREATMENT RESPONSE TO HIGH INTENSITY FOCUSED ULTRASOUND
TRANSRECTAL HIGH-INTENSITY FOCUSED ULTRASOUND (HIFU) USING THE SONABLATE®500 FOR THE TREATMENT OF PROSTATE CANCER; THE PERUGIA-TURIN EXPERIENCE
Colombel M.1, Mege Lechevallier F.2, Ricci E.1, Chapelon J.Y., Gelet A.1, Martin X.1
1
1 Hospices Civils de Lyon, Dept. of Urology, Lyon, France, 2Hospices Civils de Lyon, Dept. of Pathology, Lyon, France, Hospices Civils de Lyon, Inserm, Lyon, France
Introduction & Objectives: Prostate tumor vascular density and factors that FRQWULEXWH WR WKH H[WHQW RI WXPRU DQJLRJHQHVLV PD\ LPSDFW RQ WKH HᚑFDF\ RI hyperthermia based therapies. Here we explored the relationship between the extent of prostate tumor angiogenesis and the response to HIFU. Material & Methods: Inclusion criteria: primary localized prostate cancer (T1736$OHVVWKDQ*OHDVRQRUOHVV WUHDWHGE\+,)8DQG785 SURVWDWH tumor angiogenesis evaluation by measurement of the expression of VEGF, &' 9(17$1$p DXWRPDWH HW TXDQWLᚏFDWLRQ RI WKH PLFURYHVVHO VXUIDFH DUHDXVLQJWKH3,;,7V\VWHP 1,.21p SULPDU\REMHFWLYHZDVWRHYDOXDWHWKH association between the expression level of the markers and the extent of tumor microvessel density and the response to treatment as assessed by post HIFU SURVWDWHELRSVLHVDWPRQWKV
Mearini L.1, D’urso L.2, Collura D.2, Zucchi A.1, Formiconi A.2, Muto M.2, Porena M.1 University of Perugia, Dept. of Urology, Perugia, Italy, 2Ospedale San Giovanni Bosco, Dept. of Urology, Turin, Italy Introduction & Objectives: High Intensity Focused Ultrasound (HIFU) is a relatively novel, minimally invasive therapy for prostate cancer. Data from other centres indicate that the early RQFRORJLFDO HᚑFDF\ LV SURPLVLQJ DQG WKDW LW DSSHDUV WR EH ZHOO WROHUDWHG DQG DVVRFLDWHG ZLWK D IDYRXUDEOH VLGH HᚎHFW SURᚏOH 7KLV VWXG\ LV D SUHOLPLQDU\ UHSRUW RQ RQFRORJLFDO RXWFRPHV RI patients treated with Sonablate®500 HIFU device in our centre. Material & Methods: %HWZHHQDQGPHQZLWK7710KLVWRORJLFDOO\SURYHQ adenocarcinoma of the prostate underwent transrectal HIFU in a Day Surgery setting. All patients gave informed consent, had HIFU under general or regional anaesthesia and were discharged with either a urethral or suprapubic catheter for at least 14 days. Follow up to determine RQFRORJLFDORXWFRPHLQFOXGHG 36$VDPSOHVDWPRQWKDQGWKHQHYHU\PRQWKVDIWHUWUHDWPHQW DQGDSURVWDWHELRSV\LQDOOSDWLHQWVDWPRQWKV)DLOXUHZDVGHᚏQHDFFRUGLQJWR SRVLWLYHᚏQGLQJV at follow up biopsy and/or biochemical failure (according to American Society for Therapeutic Radiology and Oncology ASTRO criteria).
Results: $WRWDORIFRQVHFXWLYHSDWLHQWV s\R ZHUHLQFOXGHGDPRQJ WKHP UHVSRQGHUV QHJDWLYH ELRSVLHV DQG ZLWK UHVLGXDO FDQFHU SRVLWLYH biopsies). Results showed a strong association between the level of local tumor angiogenesis and the mean surface area of microvessels and response to WUHDWPHQW $129$&'H[SUHVVLRQ S $129$PHDQVXUIDFHDUHD S 0.006). On the contrary there was no association between the expression level of VEGF and treatment response
Results: 0HGLDQDJHZDV\UV 6' PHGLDQEDVHOLQH36$YDOXHZDVQJPO 6' *OHDVRQ VFRUH UDQJHG VWDJH RI GLVHDVH ZDV 7 LQ SWV 7 LQ SWV DQG 7D LQ SDWLHQWV0HGLDQSURVWDWHYROXPHZDVPO 6' 0HGLDQWUHDWPHQWWLPHZDV PLQXWHV 6' 0HGLDQIROORZXSZDVPRQWKV 6' $IWHU+,)8WUHDWPHQW36$GURSSHGWRD median nadir value of 0.18 ng/ml (SD 1.9). The median PSA value at three and six months were QJPO 6' DQGQJPO 6' UHVSHFWLYHO\$WPRQWKVSHUFHQWDJHRIQHJDWLYH ELRSV\ZDVSDWLHQWVZHUHUHWUHDWHGZLWK+,)8ZKLOHWKHRWKHUVZLWK(%57RUKRUPRQH therapy. According to ASTRO criteria, there was bio chemically no evidence of disease (bNED) LQ RYHUDOO5LVNVWUDWLᚏFDWLRQXVLQJWKH'ಬ$PLFRFULWHULDVKRZWKDWMXVWFRQVLGHULQJWKHORZ and intermediate risk group, the bNED is 87.2%. At univariate analysis, a negative biopsy at 6 months and bNED was statistically associated with a lower baseline PSA values and lower PSA nadirs at 1 month, T1-T2 stage and a lower Gleason score. At multivariate analysis, only baseline PSA is an independent predictor of a positive biopsy, while only clinical stage is an independent predictor of bNED.
Conclusions: This study suggest as expected that the physical action of HIFU is not dependent on the tumor grade but rather on the tissue properties (tumor and stroma). The local angiogenesis might limit the action of hyperthermia et may explain the synergic action of anti angiogenic drugs as observed in animal models
Conclusions: We have demonstrated promising early oncological outcomes using the Sonablate®500 for the treatment of prostate cancer. These data are in line with other European centres which attest to the reproducibility of the treatment regimen. We have found that outcome is positively associated with a lower baseline PSA, lower PSA nadir, lower Gleason score and lower tumour stage. As with any novel technology, long term data will be required before this technique gains widespread clinical acceptance outside of specialist centres.
199 RESIDUAL PROSTATE CANCER AFTER A FIRST HIFU SESSION: ONCOLOGICAL BENEFITS OF A SECOND SESSION Murat F.J.1, Poissonnier L.1, Pricaz E.1, Rouviere O.2, Chapelon J.Y., Colombel M.1, Gelet A.1
P12 TAPES FOR URINARY INCONTINENCE Wednesday, 26 March, 14.30-16.00, Blue Hall 1
200
PRE AND INTRA-OPERATIVE PREDICTIVE FACTORS OF OCCULT STRESS INCONTINENCE IN PATIENTS WITH A SYMPTOMATIC PROLAPSE FOR APPLICABILITY OF SLING OPERATIONS Farahat Y.1, Awara A.2
1 Edouard Herriot Hospital, Dept. of Urology, Lyon, France, 2Edouard Herriot Hospital, Dept. of Radiology, Lyon, France, INSERM, Unit 556, Lyon, France
1
Introduction & Objectives: HIFU repeatability is, with its minimally invasiveness, one of the major advantages of this technique for the treatment of localized prostate FDQFHU /3&D :HHYDOXDWHGWKHRQFRORJLFDOHᚑFDF\RIDVHFRQG+,)8VHVVLRQIRU residual LPCa.
Introduction & Objectives: For patients with prolapse and occult stress incontinence (OSI), we tried to apply some predictive factors before prolapse repair and intraoperative after the repair to identify patients who were really in need for sling operation to avoid unnecessary procedure.
Material & Methods: Between 01/2000 and 05/2005, 227 patients, mean age 69.9, UHFHLYHG+,)8VHVVLRQVDPRQJWKHZKRUHFHLYHG+,)8IRU/3&DZLWKWKHᚏUVW JHQHUDWLRQ+,)8GHYLFH+,)8ZHUHGHOLYHUHGXQGHUVSLQDODQHVWKHVLDXVLQJWKHᚏUVW generation of Ablatherm HIFU device. Low and intermediate risk patients were 79 DQGUHVSHFWLYHO\ZLWKDPHDQ36$DQGSURVWDWHYROXPHRIQJPODQGFF respectively on initial evaluation. Follow-up included serial PSA measurements every PRQWKVV\VWHPDWLFFRQWUROELRSVLHVPRQWKVSRVW+,)8DQGDGGLWLRQDOELRSVLHVLQ FDVHRIULVLQJ36$7KH3KHQL[FULWHULDIRUVDOYDJHWUHDWPHQWZHUHXVHGWRGHᚏQHWKH disease-free survival rate (DFSR).
Material & Methods: 145 female patients with prolapse without associated urinary complaint who are undergoing surgical repair of pelvic organ prolapse were subjected preoperatively to repositioning of their prolapse using pessary and then subjected to pad test and urodynamic studies to evaluate for occult SI. Occult stress incontinence ZDVGHᚏQHGDVDSRVLWLYHVWUHVVWHVWZLWKUHSRVLWLRQLQJRIWKHSURODSVH2QO\SDWLHQWV ZKRKDG26,DIWHUUHSRVLRQLQJRIWKHLUSURODSVH ZHUHHQUROOHGLQWKHVWXG\$OOWKH patients underwent prolapse repair and then re-evaluated intraoperatively by stress test. All the patients demonstrated intraoperative +ve stress tests -after the repair- underwent 797DQGZHUHH[FOXGHGIURPWKHVWXG\ SDWLHQWV :KLOHದYHVWUHVVWHVWSDWLHQWV patients) were divided randomly into 2 groups: group I: 15 patients underwent sub urethral sling (TVT) group II: 15 patients without additional anti incontinence procedure. Both groups were evaluated both subjectively and objectively by urodynamic studies at DQGPRQWKVSRVWRSHUDWLYHO\
Results: Retreatment was decided because of positive biopsy during systematic control (58%) or PSA rise (42%) with a mean delay of 16.6 months between 2 sessions. The pre-HIFU retreatment PSA and prostate volume were 2.1 +/-2.2 and 9.5 +/-5 cc, respectively. 17% only had a Gleason sum superior to the initial Gleason including 4% of Gleason equal or superior to 8. Prostate recurrence was equally GLVWULEXWHGLQWKHSURVWDWH DSH[PLGEDVH 0HDQSRVWQG+,)8 follow-up was 25 months. Mean post-2nd HIFU PSA nadir and prostate volume were 0.66 +/- 1.44 ng/ml and 7 +/- 6.7 cc, respectively. Control biopsies were negative in RIWKHSDWLHQWVZKRDFFHSWHGV\VWHPDWLFFRQWURO$FWXDULDO\HDUVSHFLᚏF VXUYLYDO ZDV $FWXDULDO \HDU ')65 ZDV ZLWK VLJQLᚏFDQW GLᚎHUHQFH between low and intermediate risk patients, 67% and 46%, respectively (p=0.05). Conclusions: +DOIRIWKHSDWLHQWVZLWKUHVLGXDO/3FDDIWHUDᚏUVW+,)8VHVVLRQZLOOEH GLVHDVHIUHHDW\HDUVIROORZLQJDVHFRQG+,)8SURFHGXUH+,)8RᚎHUVWKHXQLTXH opportunity to be repeated with no limited doses conversely to radiation.
Eur Urol Suppl 2008;7(3):120
Tanta University, Dept. of Urology, Tanta, Egypt, Gynaecology and Obstetric, Tanta, Egypt
2
Tanta University, Dept. of
Results: ,QJURXS, SDWLHQWVZLWK797 QRFOLQLFDOO\GHWHFWHG6,LQDOOSDWLHQWVDWDQG PRQWKVIROORZXSEXWRXWRISDWLHQWVKDGXURG\QDPLFDOO\6,ZKLFKQRWDᚎHFWLQJ her QoL and no extra maneuver was required. 2 patients in this group developed lower urinary obstructive symptoms and were catheterized for extra 10 days post operatively. in group II (15 patients without TVT) 1 out of 15 patients had clinically detected SI at PRQWKV IROORZ XS DQG 797 ZDV SHUIRUPHG DW PRQWKV LQ DGGLWLRQ SDWLHQWV KDG XURG\QDPLFDOO\6,ZKLFKQRWDᚎHFWLQJWKHLU4R/DQGQRH[WUDPDQHXYHUZDVUHTXLUHG Conclusions: Routine use of sling with prolapse repair as a prophylactic procedure for occult SI is not recommended. Preoperative evaluation of occult SI is not usually accurate, therefore combined preoperative and intraoperative testing is useful to identify women with prolapse who are really in need for sling operation after prolapse repair to avoid unnecessary sling procedures.