Bladder neck needle suspension for urinary incontinence in women.
BACKGROUND
Bladder neck needle suspension is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience some urinary incontinence, and about a third of them have moderate or severe symptoms.


OBJECTIVE
To determine the effects of needle suspension on stress or mixed urinary incontinence in comparison with other management options.


METHODS
We searched the Cochrane Incontinence Group specialised register and reference lists of relevant articles. Date of last search: December 2001.


METHODS
Randomised or quasi-randomised trials that included needle suspension for the treatment of urinary incontinence.


METHODS
Trials were assessed and data extracted independently by at least two reviewers. One trial investigator was contacted for additional information.


RESULTS
Eight trials were identified which included 327 women having six different types of needle suspension procedures and 407 who received comparison interventions. Needle suspensions were more likely to fail than open abdominal retropubic suspension (higher subjective failure rate after the first year (70/267, 26% failed vs 33/243, 14% failed after open abdominal retropubic suspension: RR 2.10, 95% CI 1.45 to 3.04) and there were more peri-operative complications (36/75, 48% vs 23/77, 30%; RR 1.51, 95% CI 1.06 to 2.15), but there were no significant differences for other outcome measures. This effect was confined to women with primary incontinence: too few women with recurrent incontinence were studied to draw conclusions about the effects of secondary operations. Needle suspensions may be as effective as anterior vaginal repair (46/128, 36% failed after needles vs 50/129, 39% after anterior repair; RR 0.93, 95% CI 0.68 to 1.26) but there was little information about morbidity. Data for comparison with suburethral slings were inconclusive because they came from a small and atypical population. No trials compared needle suspensions with conservative management, peri-urethral injections or sham or laparoscopic surgery.


CONCLUSIONS
Bladder neck needle suspension surgery is probably not as good as open abdominal retropubic suspension for the treatment of primary genuine stress urinary incontinence in terms of lower cure rates and higher morbidity. However, the reliability of the evidence was limited by poor quality and small trials. There was not enough information to comment on secondary procedures or on comparisons with suburethral sling operations. Although cure rates were similar after needle suspension compared with after anterior vaginal repair, the data were insufficient to be reliable and inadequate to compare morbidity.
Glazener
C M
CM
Health Services Research Unit (Foresterhill Lea), University of Aberdeen, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZD. c.glazener@abdn.ac.uk
Cooper
K
K
D005260:Female; D006801:Humans; D009339:Needles; D016032:Randomized Controlled Trials as Topic; D013536:Suture Techniques; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*