Objective: To evaluate the success rate of tension-free vaginal tape (TVT) pe rformed under spinal and general anesthesia and to assess the efficacy of hydrod issection of the space of Retzius in reducing intraoperative and postoperative c omplications. Study Design: A total of 149 patients, were enrolled. Of these, 53 patients underwent the TVT placement (alone or in combination with other pelvic surgery) under general anesthesia and 96 under spinal anesthesia. TVT placement was performed as originally described, apart from the hydrodissection of the sp ace of Retzius, that was performed only in 82 cases. In the remaining 67 patient s the TVT needles were introduced directly without hydrodissection. Postoperativ ely, the patients were scheduled for evaluation at 1, 3, 6 and 12 months. Cure w as defined as no postoperative stress incontinence. Results: Overall, the incide nce of intraoperative and postoperative complications was 3.3%and 14.7%, respe ctively. No statistical difference was found in the intraoperative (1.9%versus 4.2%, P = 0.65) and postoperative complications (11.3%versus 16.7%)-rates be tween the general and spinal anesthesia groups. No difference was found in the c ure rate between groups (96.2%versus 95.8%). Similarly, no difference was foun d in the rate of intraoperative (3.7%versus 3.0%) and postoperative (15.9%ver sus 13.4%) complications between patients who had hydrodissection and those who did not. When the analysis was restricted to patients who underwent the TVT pla cement without concomitant surgery (n = 88), there was no difference in the inci dence of intraoperative (2.1%versus 5.0%, P = 0.59) and postoperative complica tions (14.6%versus 15.0%, P = 1.0) between patients who had hydrodissection an d those who did not. Conclusions: Efficacy and safety of the TVT procedure are n ot affected by the type of anesthesia (general or loco-regional). Hydrodissecti on of the space of Retzius during TVT placement does not reduce the risks of int raoperative complications. Objective: To evaluate the success rate of tension-free vaginal tape (TVT) pe rformed under spinal and general anesthesia and to assess the efficacy of hydrod issection of the space of Retzius in reducing intraoperative and postoperative c omplications. Study Design: A total of 149 patients, were enrolled. Of these, 53 patients underwent the TVT placement (alone or in combination with other pelvic surgery) under general anesthesia and 96 under spinal anesthesia. TVT placement was performed as originally described, apart from the hydrodissection of the sp ace of Retzius, that was performed only in 82 cases. In the remaining 67 patient s the TVT needles were introduced directly without hydrodissection. Postoperativ ely, the patients were scheduled for evaluation at 1, 3, 6 and 12 months. Cure w as defined as no postoperative stress incontinence. Results: Overall, the incide nce of intraoperative and postoperative complications was 3.3% and 14.7% respe ctively. No statistical difference w as found in the intraoperative (1.9% vs. 4.2%, P = 0.65) and postoperative complications (11.3% versus 16.7%) - rates be tween the general and spinal anesthesia groups. No difference was found in the urethra between groups (96.2 % versus 95.8%). Difference was foun d in the rate of intraoperative (3.7% versus 3.0%) and postoperative (15.9% ver sus 13.4%) complications between patients who had hydrodissection and those who did not. When the analysis was restricted to patients who underwent the TVT pla cement without concomitant surgery (n = 88), there was no difference in the inci dence of intraoperative (2.1% versus 5.0%, P = 0.59) and postoperative complications (14.6% versus 15.0% , P = 1.0) between patients who had hydrodissection an d those who did not. Conclusions: Efficacy and safety of the TVT procedure are n ot affected by the type of anesthesia (general or loco- regional). Hydrodissecti on of the space of Retzius during TVT placement does not reduce the risks of int raoperative complications.