Transvaginal needle suspension operation: The way we do it - Clinical and urodynamic study: Long-term results

Objectives: To evaluate the long-term results of the transvaginal needle su spension operation for urinary stress incontinence. Materials and Methods: A total of 88 women with proved genuine stress incon tinence were treated with transvaginal needle suspension with fixation of s uspension sutures to the rectus fascia using the technique of crossing susp ension sutures. By using this method the proximal end of suspension suture from one side is tied with the distal end of suspension suture from the oth er side. The suspension sutures fixed in this way ensure 3-4 cm of rectus f ascia which is used as a carrier of the suspension sutures. The same urolog ist peformed 88 consecutive operations. Clinical and urodynamic evaluations were performed at 6 months, 1 year and 5 years after surgery with the same technique and the same equipment. Results: Analysis of the questionnaire showed that 81 patients (92.0%) were continent after 6 months while 78 (88.6%) patients were still continent af ter 1 year. After 5 years (n = 71)there were only continent 54 (76.0%) and incontinent patients (n = 17, 23.9%). Urodynamic analysis showed that 49 (6 9.0%) patients were continent after 5 years In = 71). The increase in the n umber of incontinent patients is achieved at the cost of the previously con tinent patients. Of the 22 incontinent patients (after 5 years), 16 were st ill stress incontinent, while 6 (8.3%) patients had urge incontinence due t o de novo detrusor instability. Three patients (n = 88, 3.4%) had undergone unilateral suture removal due to infection without influence on their cont inence status. In 2 patients (n = 88, 2.2%) the clinical pictures were high ly suggestive of ilioinguinal nerve entrapment. Conclusions: Our results suggest that the transvaginal needle suspension op eration is satisfactory for the management of genuine stress incontinence i n women. However, we believe that the success of any suspension operation l ies in adequate mobilization of the bladder neck and urethra (anterior vagi nal wall) as well as in a surgeon's familiarity with the procedure. Copyrig ht (C) 2000 S. Karger AG, Basel.