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 1,000 gm. 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 600 gm. 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.