Objective: To investigate the efficacy of the tension- free vaginal tape (TVT) procedure for the management of stress urinary incontinence (SUI) in elderly women. Method: A total of 55 women aged between 65 and 86 years underwent a TVT procedure for urodynamic SUI. Of these, 15 (27% ) had undergone previous surgery for treatment of SUI. Before the TVT procedure, a complete medical history was taken and a gynecologic examination performed. Results: Operating time ranged between 11 and 35 min (excluding the time of concomitant surgery, if any); hospitalization time ranged between 1 and 5 days; and no severe intraoperative or postoperative complications occurred. Cure occurred in 39 (76% ) of 51 evaluable patients and its rate was positively associated with bladder neck mobility. Among patients in whom the angle of displacement on the Q- tip test was less than 30° , 42% became continent whereas among those in whom it was 30° or higher, 90% became continent (P < .001). Among those in whom the angle was between 20° and 30° , 57% became continent, and among those in whom it was less than 10° , 80% remained incontinent. Conclusion: The TVT procedure in elderly women with SUI offers a satisfactory cure rate; however, in patients with significantly decreased bladder neck mobility (an angle < 20° on the Q- tip test), the results are not encouraging. Objective: To investigate the efficacy of the tension-free vaginal tape (TVT) procedure for the management of stress urinary incontinence (SUI) in elderly women. Method: A total of 55 women aged between 65 and 86 years underwent a TVT procedure for urodynamic SUI. Of these, 15 (27%) had undergone previous surgery for treatment of SUI. Before the TVT procedure, a complete medical history was taken and a gynecologic examination performed. Results: Operating time ranged between 11 and 35 min (excluding the time of concomitant surgery, if any); hospitalization time ranged between 1 and 5 days; and no severe intraoperative or postoperative sessions occurred. Cure occurred in 39 (76%) of 51 evaluable patients and its rate was positively associated with bladder neck mobility. Among patients in whom the angle of displacement on the Q-tip test was less than 30 °, 42% became continent among those of in in it it was 30 ° or higher, 90% became continent (P <.001). m the angle was between 20 ° and 30 °, 57% became continent, and among those in whom it was less than 10 °, 80% remained incontinent. Conclusion: The TVT procedure in elderly women with SUI offers a satisfactory cure rate; however , in patients with significantly decreased bladder neck mobility (an angle <20 ° on the Q-tip test), the results are not encouraging.