Laparoscopic bladder neck suspension fails the test of time

Purpose: Initial reports on laparoscopic bladder neck suspension have sugge sted success rates similar to those of traditional bladder neck suspension; We compare long-term success rates of laparoscopic and transvaginal Rat bl adder neck suspension. Materials and Methods: A total of 100 patients with anatomical stress urina ry incontinence underwent extraperitoneal laparoscopic bladder neck suspens ion with securing of the endopelvic fascia to Cooper's ligament (58, laparo scopy group) or transvaginal Rat bladder neck suspension (42, transvaginal group). Patients were evaluated by chart review and telephone questionnaire to determine whether they had urinary incontinence. Results: The 2 groups were similar in terms of age, mean body mass index, p reoperative bladder capacity and post-void residual. Mean followup was 45 m onths (range 14 to 71) in 50 laparoscopy group (86%) and 59 months (range 3 5 to 72) in 29 transvaginal group (70%) patients. Only 15 of 50 laparoscopy group (30%) and 10 of 29 transvaginal group (35%) patients were completely continent at followup. There was no statistically significant difference i n the success rates for the 2 groups. Mean time to failure for both groups was 18 to 24 months. Conclusions: With long-term followup laparoscopic bladder neck suspension d emonstrated poor success rates similar to other minimally invasive surgical therapies for stress urinary incontinence. Any new surgical technique for treatment of stress urinary incontinence should have a mean followup of mor e than 2 years to determine true clinical efficacy.