DOES BONE ANCHOR FIXATION IMPROVE THE OUTCOME OF PERCUTANEOUS BLADDERNECK SUSPENSION IN FEMALE STRESS URINARY-INCONTINENCE

Objective To evaluate the outcome of a new modification of percutaneou s needle suspension, using a bone anchor system for fixing the suture at the pubic bene, and to compare the results with those published pre viously. Patients and methods From March 1996, 37 patients with stress urinary incontinence (>2 years) were treated using a bone anchor syst em. On each side the suture was attached to the pubocervical fascia an d 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 questionna ire, over a mean follow-up of 11 months (range 6-18). Results In the 3 7 patients, the procedure was successful in 25 (68%), with 16 (43%) of the patients completely dry and nine (24%) significantly improved, Re moval of the bone anchor and suture was necessary in two patients, bec ause of unilateral bacterial infection in one and a bilateral soft tis sue granuloma in the other. One bone anchor became dislocated in a thi rd patient. In two cases where the treatment failed, new detrusor inst ability was documented urodynamically. Minor complications were prolon ged 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 modifi ed needle suspension procedures and does not reinforce the optimistic results of bone anchoring published recently. Because of the poorer lo ng-term results from percutaneous needle suspension than from other te chniques of open retropubic bladder neck suspension, it remains questi onable whether percutaneous needle suspension should be considered a f irst-line procedure for the treatment of female stress urinary inconti nence.