Stamey Bladder Neck Suspension Research Articles

Delayed reaction to the Dacron buttress used in Stamey bladder neck suspension

Stamey bladder neck suspension is thought to be an excellent procedure for stress urinary incontinence in selected groups of patients. However we must not ignore the complications of this procedure. We report a case of a patient who developed a delayed reaction with bladder wall erosion to the Dacron buttress used in Stamey urethropexy 19 years before. She was presented with pelvic pain and persisting irritative bladder symptoms. The treatment of choice was cystoscopic removal of suture and buttress. Tissue intolerance is a common problem with the use of different kinds of biomaterials in incontinence surgery. Careful cystourethroscopy is essential for early diagnosis and treatment if pain, infections and severe irritative symptoms occur postoperatively.

Long-term chronic complications from Stamey endoscopic bladder neck suspension: a case series

Purpose/objective Long-term complications from anti-incontinence surgical procedures are rarely reported. We report on delayed presentation of complications relating to the synthetic bolster placed for the Stamey bladder neck suspension. Patients undergoing re-operative surgery following prior Stamey endoscopic bladder neck suspension were selected from a surgical database. Four women with lower urinary tract and/or vaginal symptoms following prior Stamey endoscopic bladder neck suspension were identified. All patients had undergone removal of the bolster material by a single surgeon (ESR) at re-operation. Preoperative, operative, and postoperative inpatient and outpatient records were reviewed. Patients presented with a variety of symptoms including urinary incontinence, recurrent cystitis, vaginitis, and urinary frequency at 9, 11, 11, and 12 years after Stamey bladder neck suspension. In addition, two patients presented with recurrent, intermittent bloody vaginal discharge and two patients complained of recurrent urinary tract infections and irritative voiding symptoms. All patients underwent transvaginal excision of the Dacron bolster. Three patients also underwent placement of an autologous pubovaginal sling for symptomatic recurrent stress urinary incontinence. At a mean follow-up of 30 months all four patients were improved. There was no recurrence of vaginal discharge or urinary tract infections. Irritative voiding symptoms resolved. Delayed complications from surgically implanted synthetic materials can present many years after initial implantation. The clinical findings are often subtle and require a high degree of suspicion. Vaginal discharge and irritative urinary symptoms in patients with even a remote history of Stamey bladder neck suspension should prompt a thorough vaginal exam and cystoscopy. Excision of the bolsters can be performed and is usually followed by symptomatic improvement.

Stamey's abdominovaginal needle colposuspension for the correction of female genuine stress urinary incontinence--long-term results.

To evaluate the long-term continence rate, subjective satisfaction and treatment-associated morbidity in a carefully selected group of patients undergoing Stamey bladder neck suspension. We studied 24 women with objectively validated genuine stress urinary incontinence (GSI) who were treated using the Stamey needle colposuspension method. Follow-up was performed by means of a questionnaire, a urodynamic assessment and a new standardized quantification test. Time to follow-up ranged from 28 to 100 months (mean 63 months). Of the 24 patients, 20 (83%) reported an improvement in clinical symptoms for a mean of 37 (range 12-84) months at the evaluation and 10 (42%) were completely continent after the Stamey procedure. Four patients (17%) reported a poor outcome of the operation, but in only one case could this be related to recurrent GSI. Treatment-associated morbidity was low but the frequency of postoperative urgency symptoms was higher than that reported in other studies (21%). In a selected population of pure GSI patients with no demonstrable detrusor overactivity, the Stamey bladder neck suspension procedure appears a feasible therapeutic option with few complications.

Complications of Stamey Needle Suspension for Female Stress Urinary Incontinence

Introduction: The Stamey bladder neck suspension for stress urinary incontinence in females is thought to be an excellent procedure. However, recent studies revealed that complications of this procedure have not been negligible. In this retrospective study, complications of the Stamey needle bladder neck suspension were examined. Materials and Methods: The Stamey procedure was performed either alone or in combination with anterior colporrhaphy for 86 female patients with stress urinary incontinence between 1989 and 1999. The mean follow-up period was 37.6 months and the mean age was 59.1 years. We studied the complications postoperatively pointed out by patients’ complaint and image examination. Results: The overall incidence of complications was 37.2%. Voiding difficulties and lower abdominal pain were present in 15 cases, respectively. We experienced 2 unusual cases in whom suspensory stitches had to be removed due to abdominal pain. Conclusions: Although the Stamey bladder neck suspension is thought to be an excellent procedure for stress urinary incontinence, surgeons should beware of possible complications and be alert of the symptoms, such as abdominal pain and bladder irritation.

DIAGNOSING BLADDER OUTLET OBSTRUCTION IN WOMEN

There are no universally accepted urodynamic criteria for diagnosing female bladder outlet obstruction. When accepted criteria for men are applied to women, the diagnosis of obstruction may often be missed, which is most likely due to differences in voiding dynamics. We propose video urodynamic criteria for diagnosing obstruction in women, and describe the urodynamic findings in those with and without obstruction. We reviewed the charts of 331 women who underwent multichannel video urodynamics for nonneurogenic voiding dysfunction. Of these women 261 (mean age 55.8 years) had evaluable voiding pressure flow studies with simultaneous video fluoroscopy of the bladder outlet during voiding. At video urodynamics cases were classified as obstructed if there was radiographic evidence of obstruction between the bladder neck and distal urethra in the presence of a sustained detrusor contraction. Strict pressure flow criteria were not used. Maximum flow rate, detrusor pressure at maximum flow rate, post-void residual, bladder capacity and the incidence of detrusor instability were compared between obstructed and unobstructed cases. A total of 76 women met the criteria for obstruction (mean age 57.5 years), while 184 (mean age 55) did not. Causes of obstruction were dysfunctional voiding in 25 cases, cystocele in 21, primary bladder neck obstruction in 12, iatrogenic from incontinence surgery in 11, urethral stricture in 3, uterine prolapse in 2, urethral diverticulum in 1 and rectocele in 1. Obstructed cases had lower mean maximum flow rate (9 versus 20.2 ml. per second, p <0.0001), higher mean detrusor pressure at maximum flow rate (42.8 versus 22.1 cm. water, p <0.0001) and higher mean post-void residual (157 versus 33 ml., p <0.0001). There was no difference in bladder capacity (381 versus 347 ml.) or incidence of detrusor instability (45 versus 41%). Using the proposed video urodynamic criteria obstructed cases had significantly higher voiding pressures, lower flow rates and higher post-void residual than unobstructed cases, as expected. However, absolute values, especially for voiding pressure, are not as dramatic in women as in men. Pressure flow studies alone may fail to diagnose obstruction but simultaneous imaging of the bladder outlet during voiding greatly facilitates diagnosis.

Long-term results of the Stamey bladder neck suspension: direct comparison with the Marshall-Marchetti-Krantz procedure

Correspondence to Mr Christopher R. Chapple, Urology Research Department, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Tel: +44 114 271 2791; fax: +44 114 279 8318 Royal Hallamshire Hospital, Sheffield, UK

A questionnaire-based outcome analysis of the Stamey bladder neck suspension procedure for the treatment of urinary stress incontinence: the Hannover experience.

To evaluate the long-term continence rate, including subjective satisfaction and therapy-associated morbidity, of patients undergoing Stamey bladder neck suspension. Eighty-five women (median age 55 years, range 30-85) with urinary stress incontinence treated by Stamey bladder neck suspension at our institution between 1987 and 1995 were evaluated using an anonymous questionnaire over a mean (range) follow-up of 61 (13-93) months. Of the 85 patients, 44 (52%) reported an improvement in clinical symptoms at the evaluation and 29 (34%) were completely continent after the Stamey procedure. However, 53 (62%) patients reported subjective satisfaction with the result, because they had a durable improvement in continence for a mean (range) of 44 (10-79) months. There was no correlation between the number of previous urogynaecological operations undergone by the patients and the success of the Stamey procedure. However, the frequency of complications other than urinary retention was significant during and after surgery, at 27%, and in accord with the complication rate reported in earlier studies. Compared with other bladder neck suspension procedures, e.g. Burch colposuspension, the Stamey procedure appears to be associated with a higher frequency of postoperative recurrent urinary stress incontinence. Therefore, the Stamey procedure should only be used if the patient demands a minimally invasive surgical procedure for bladder neck suspension. Although approximately equal to 60% of patients were satisfied with the durable improvement in clinical symptoms, it is appropriate to inform patients before surgery of the high recurrence rate after Stamey bladder neck suspension.

Effect of study methodology on long-term outcome of the Stamey bladder neck suspension procedure

Effect of study methodology on long-term outcome of the Stamey bladder neck suspension procedure

Long-Term Results of the Stamey Bladder Neck Suspension Procedure: A Patient Questionnaire Based Outcome Analysis

Purpose Reported success rates of the Stamey bladder neck suspension procedure vary from 39 to 91%. The disparity is substantially influenced by the methods used to assess the surgical outcome, with best results being found consistently in retrospective chart review studies. We assessed the true long-term outcome of the Stamey bladder neck suspension with a patient questionnaire based outcome analysis using strict definitions for cure and recurrence. Materials and Methods Of 172 consecutive patients 138 (80.2%) returned a questionnaire designed to assess the outcome of the procedure and the subjective satisfaction with the operative result. To our knowledge we report the longest mean followup for this procedure (66 months). Results Of 130 evaluable patients with hypermobility or intrinsic sphincter deficiency leading to urinary stress incontinence 65 (50.0%) remained completely continent, 15 (11.5%) never became continent and 50 (38.5%) had recurrence 6 to 90 months after initial operative success. However, approximately two-thirds of the patients believed they were cured or substantially improved more than 5 years postoperatively. Conclusions Despite the considerable failure rate, the substantial improvement in the quality of life of almost two-thirds of the patients during long-term followup and the lack of superior techniques quality the Stamey bladder neck suspension as a treatment of choice for urinary stress incontinence in women. We strongly emphasize the need for standardized questionnaire based outcome analyses for the evaluation of incontinence surgery.

Long-Term Results of the Stamey Bladder Neck Suspension Procedure

Long-Term Results of the Stamey Bladder Neck Suspension Procedure

Peri-urethral silicone microimplants (Macroplastique) for the treatment of genuine stress incontinence.

To establish the safety and efficacy of the periurethral injection of silicone microimplants (Macroplastique) for the treatment of genuine stress incontinence in women. Forty women (median age 50 years, range 27-74) with genuine stress incontinence confirmed on medium-fill video-cystometry were recruited to the study. Macroplastique (3-7 mL) was injected periurethrally 1 cm distal to the bladder neck at three or four points 'around the clock' under cystoscopic control. Where possible, the urodynamic study was repeated after 3 months. Results were graded as excellent (dry, no protection), good (better, but not totally dry) or poor (no improvement). Three months after a single injection, 16 (40%) were completely dry, 13 (33%) were improved and 11 (27%) were no better. Four patients who were improved were rendered dry by a second injection. After 3 years, 16 (40%) remained completely dry, seven (18%) were improved and 17 (42%) required alternative treatment with a Stamey bladder neck suspension. Dysuria for 48 h occurred in almost all patients; two were catheterized overnight and one required a catheter for 6 weeks. A comparison of maximum voiding pressures and flow rates before and 3 months after a single injection of Macroplastique revealed no urodynamic evidence of obstructed voiding (n = 25). Injectable silicone microimplants produced a good to excellent result in 73% of patients in the short-term and 58% of women maintained this response after 3 years. The injection is a day-case procedure which provides a satisfactory medium-term outcome in over half of patients with genuine stress incontinence. There are few side-effects and those patients with no improvement may go on to be treated by open surgery without complication.

Should Stamey colposuspension be our primary surgery for stress incontinence?

To evaluate the outcome of the Stamey procedure for stress incontinence and to decide if it is an acceptable first-line option for the treatment of patients. Between June 1987 and March 1993 67 women had Stamey bladder neck suspension carried out for the treatment of stress incontinence. In September 1993 all patients received a detailed questionnaire to ascertain their present status. Immediately after surgery 70% of patients were dry and 15% were much improved. At 6 months 56% of patients were dry and 21% were much improved. More than 1 year following surgery, of 58 patients responding only 31% were dry and 28% were much improved. More than 5 years after surgery only 18% of the 28 women responding were dry. The factors which were significantly associated with failure were obesity (P < 0.005) and the number of pads used per day (P < 0.05). Previous surgery may also be an important factor. The Stamey vesical neck suspension has a good early success rate but the results in the longer term are not acceptable. This operation should not be used as a first-line treatment for stress incontinence and should be reserved for specific patient subgroups.

Surgical therapy of recurrent stress incontinence

We reviewed 245 patients, who underwent surgical treatment of stress urinary incontinence between 1982 and 1989. All patients underwent clinical and urodynamic assessment before and an average of 23 months after surgery (range 12-28). 159 patients had not undergone a previous incontinence operation and 86 one or more previous procedures. 42 patients with recurrent stress incontinence underwent a Burch colposuspension, 20 an anterior colporrhaphy and colpoperineoplasty, and 24 a Stamey endoscopic bladder neck suspension. All operations were successful, more frequently in patients undergoing the first surgical attempt at correction of incontinence than in those undergoing surgery for recurrent incontinence (Burch colposuspension 88% vs 69%; anterior and posterior repair 62% vs 20%; Stamey bladder neck suspension 80% vs 52%). In patients with severe stress incontinence both the Burch and Stamey procedures yielded significantly better results than anterior and posterior repair (73% and 66% vs 37%). The urethral closure pressure at rest was unchanged in patients continent after surgery, but significantly reduced in the surgical failures. Stress profile values differed significantly between patients continent after surgery and surgical failures. Also, the vesicourethral junction was elevated further in the continent than in the incontinent women.

Quantifying Thread Tension is of Clinical Use in Stamey Bladder Neck Suspension: Analysis of Clinical Parameters

Tension on the nylon loops in a Stamey endoscopic bladder neck suspension has been quantified for the first time by using a spring scale. Clinical data were compared between 14 patients with undetermined tension (control group) and 57 with tension of either 400, 600, 700, 800 or 1,000gm. Experimental study during the operation demonstrated that changes in the posterior urethrovesical angle and distance that the bladder neck was elevated were not proportional to the tension: the lower the thread tension the larger the change in these 2 parameters. Compared to the control group a significant decrease in the period of suprapubic drainage was observed in patients with quantified tension. Operative success was obtained in 86 per cent of the control group and 91 per cent of those in whom tension was quantified. A tension of 400 to 600gm. seemed to be most appropriate for a successful outcome. We conclude that quantifying the thread tension is useful to prevent either over-tightness of the nylon loops or insufficient suspension of the bladder neck, and that with a spring scale it is easy to instruct a beginner on how tightly to tie the threads. (J. Urol., 141: 38-42, 1989)

Assessment of the results of Stamey bladder neck suspension.

A total of 48 patients with genuine stress incontinence underwent endoscopic bladder neck suspension; 36 patients (75%) were completely cured of their incontinence but 12 (25%) suffered recurrent leakage. In 2 cases this was due to infection and erosion of the vaginal sutures; in 4 cases failure was ascribed to a small capacity bladder and "pipe-stem" urethra. In the remaining 6 unsuccessful cases the Stamey sutures had cut through flimsy endopelvic fascia. It was concluded that endoscopic bladder neck suspension has advantages over colposuspension in terms of reduced dissection and hospital stay, but its success rate is lower than originally reported. Failures due to suture infection and buttress displacement may be avoided by not using Dacron and, instead, by picking up vaginal subdermis with nylon sutures--the same tissue used to provide support in a Burch colposuspension.

316 - The Stamey Bladder Neck Suspension Operation for Patients with Stress Incontinence and Neurovesical Dysfunction

No AccessJournal of Urology1 Jun 1987The Stamey Bladder Neck Suspension Operation for Patients with Stress Incontinence and Neurovesical Dysfunction William T. Lawrence, David G. Thomas, Michael C. Bishop, and Patrick C. Bates William T. LawrenceWilliam T. Lawrence More articles by this author , David G. ThomasDavid G. Thomas More articles by this author , Michael C. BishopMichael C. Bishop More articles by this author , and Patrick C. BatesPatrick C. Bates More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75466-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "The Stamey Bladder Neck Suspension Operation for Patients with Stress Incontinence and Neurovesical Dysfunction." The Journal of Urology, 137(6), p. 182A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 182A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information William T. Lawrence More articles by this author David G. Thomas More articles by this author Michael C. Bishop More articles by this author Patrick C. Bates More articles by this author Expand All Advertisement Loading ...