Transvaginal needle suspension procedures for recurrent stress incontinence

The results of transvaginal needle suspension in 36 patients with stress urinary incontinence who failed previous operation were reviewed. Eighteen patients underwent a Stamey endoscopic needle suspension, and a Peyrera-Raz cystourethropexy was performed on the remainder. Recurrent stress incontinence was confirmed by history, physical examination, and urodynamic studies. Cure rates of 78 percent for the Stamey procedure and 83 percent for the Raz operation were achieved. Excluding patients with voiding dysfunction or urge incontinence postoperatively due to bladder instability, the failure rates were 6 percent and 11 percent, respectively. Analysis of the results according to the preoperative maximal urethral pressures demonstrated that low-pressure urethras if accompanied with urethrovesical hypermobility have no impact on the results if the anatomic abnormality was corrected adequately by the needle suspension. Thus, the transvaginal needle suspension was found to be highly effective in patients with low-pressure urethras, who failed previous operation, but had persistent bladder neck hypermobility, and suggests that this method of surgical repair should be the first choice in this selected group.