Does bone anchor fixation improve the outcome of percutaneous bladder neck suspension in female stress urinary incontinence?

Abstract

Objective To evaluate the outcome of a new modification of percutaneous needle suspension, using a bone anchor system for fixing the suture at the pubic bone, and to compare the results with those published previously. Patients and methods From March 1996, 37 patients with stress urinary incontinence (>2 years) were treated using a bone anchor system. On each side the suture was attached to the pubocervical fascia and the vaginal wall via a broad ‘Z’‐stitch. A urodynamic investigation performed preoperatively in all patients confirmed stress incontinence and excluded detrusor instability. The outcome was assessed either by a clinical follow‐up investigation or using a standardized questionnaire, over a mean follow‐up of 11 months (range 6–18). Results In the 37 patients, the procedure was successful in 25 (68%), with 16 (43%) of the patients completely dry and nine (24%) significantly improved. Removal of the bone anchor and suture was necessary in two patients, because of unilateral bacterial infection in one and a bilateral soft tissue granuloma in the other. One bone anchor became dislocated in a third patient. In two cases where the treatment failed, new detrusor instability was documented urodynamically. Minor complications were prolonged wound pain in 10 (26%) and transient urinary retention or residual urine in 12 patients (32%). Conclusion The poor success rate in this study corresponds with the long‐term results of conventional or modified needle suspension procedures and does not reinforce the optimistic results of bone anchoring published recently. Because of the poorer long‐term results from percutaneous needle suspension than from other techniques of open retropubic bladder neck suspension, it remains questionable whether percutaneous needle suspension should be considered a first‐line procedure for the treatment of female stress urinary incontinence.

Transvaginal Bone Anchors in Female Stress Urinary Incontinence: Poor Results

“…Perioperative hygiene for incontinence operations at the urological clinics of the Berlin and Ulm University Hospitals is in keeping with data reported in the literature [4][5][6]11]. It, therefore, seems improbable that this factor could have caused the poor results we obtained.…”

“…The primary cure rate ranges from 70 to 100% [4,[6][7][8][9][10][11] in some studies. Other authors report poor results in the cure of stress incontinence and a high rate of impaired vaginal wound healing [5,12].…”

“…The anchor can be implanted either on the ventral side of the bone with the suspension sutures guided vaginally [4,5] or directly on the dorsal side with access from a vaginal direction. The following evaluates the results obtained with this surgical technique at two German university hospitals.…”

Minimal-invasiver Knochenanker in der Therapie der weiblichen Stressinkontinenz

“…Dieser Knochenanker kann entweder auf der ventralen Seite des Knochens implantiert werden, wobei die Suspensionsfäden über eine lange Führung nach vaginal geleitet werden [4,5], oder er wird von vaginal her auf der dorsalen Seite des Knochens direkt implantiert. Wir berichten über die Ergebnisse letzterer Operationstechnik an unserer Klinik.…”

“…Die perioperative Hygienepraxis der urologischen Klinik des Universitätsklinikums Benjamin Franklin bei Inkontinenzoperationen entspricht der Literatur [4,5,7,12]. Es erscheint daher unwahrscheinlich, dass dieser Faktor die beobachteten schlechten Ergebnisse bedingt.…”