Tansvaginal Needle Suspension Operation: The Way We Do It

Abstract

Objectives: To evaluate the long–term results of the transvaginal needle suspension operation for urinary stress incontinence. Materials and Methods: A total of 88 women with proved genuine stress incontinence were treated with transvaginal needle suspension with fixation of suspension sutures to the rectus fascia using the technique of crossing suspension 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 other side. The suspension sutures fixed in this way ensure 3–4 cm of rectus fascia which is used as a carrier of the suspension sutures. The same urologist 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 after 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 (69.0%) patients were continent after 5 years (n= 71). The increase in the number of incontinent patients is achieved at the cost of the previously continent patients. Of the 22 incontinent patients (after 5 years), 16 were still stress incontinent, while 6 (8.3%) patients had urge incontinence due to de novo detrusor instability. Three patients (n = 88, 3.4%) had undergone unilateral suture removal due to infection without influence on their continence status. In 2 patients (n = 88, 2.2%) the clinical pictures were highly suggestive of ilioinguinal nerve entrapment. Conclusions: Our results suggest that the transvaginal needle suspension operation is satisfactory for the management of genuine stress incontinence in women. However, we believe that the success of any suspension operation lies in adequate mobilization of the bladder neck and urethra (anterior vaginal wall) as well as in a surgeon’s familiarity with the procedure.