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.


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%).


CONCLUSIONS
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.
Department of Urology, Medizinische Hochschule Hannover, Germany.
D
D
Schultheiss
K
K
Höfner
M
M
Oelke
V
V
Grünewald
U
U
Jonas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D013536:Suture Techniques; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000503:physiopathology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods*