Bone anchor 4-corner cystourethropexy: long-term results

We evaluate the long-term results of incision less transvaginal bone anchor cystourethropexy to treat genuine urinary stress incontinence.

Between August 1995 and January 1997, 31 women 36 to 81 years old (mean age 58) with types I and II genuine urinary stress incontinence were treated. Four miniature bone anchors (2 on each side of the urethra) attached to a suture were fired transvaginally into the retropubic bone using a bone anchor stapler. The ipsilateral sutures were tied, thus creating a Marshall-Marchetti colposuspension.

Of the patients 3 were lost to followup and the remaining 28 were followed for at least 60 months. Only 6 patients (21.4%) are continent. In 5 patients 11 sutures passed through the bladder 5 of which were removed intraoperatively and the other 6 were detected and removed during followup. Incontinence recurred in 1 patient because the sutures cut through the vaginal tissue and were found loose in the retropubic space. In 8 patients 12 anchors had become detached from the bone of which 7 were detected on x-ray in the retropubic area, 2 were removed cystoscopically 1 year later and 3 were spontaneously expulsed through the vagina 10 months to 5 years postoperatively. In 1 patient with intravesical sutures a vesicovaginal fistula developed which was successfully repaired, and in another pubic osteomyelitis developed.

We regard 4-corner bone anchor cystourethropexy as unsuitable for genuine urinary stress incontinence based on the unfavorable outcome of incontinence and high rate of complications, including a relatively high incidence of confirmed anchor detachment.