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

OBJECTIVE

To evaluate the outcome of a new modification of percutaneous needle suspension, using a bone anchor system for fixing the suture at the public 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 by 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 the 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.