Transvaginal needle bladder neck suspension procedures for stress urinary incontinence: a comprehensive review

Transvaginal needle bladder neck suspension procedures for surgical correction of stress incontinence are increasing in popularity among genitourinary surgeons. Since 1959, three main modifications of the originally described procedure have emerged as representing various needle suspension procedures, ie, the modified Pereyra procedure among gynecologic surgeons and the Stamey and the Raz procedures among urologic surgeons. The overall success rate of 85% (range 40-100%) among a total of 1967 surgical procedures reported in the published literature may be misleading; the majority of reported studies relied upon subjective clinical cures rather than objectively demonstrable cures of urinary incontinence. The majority of studies lacked long-term follow-up of successfully treated patients. Few studies reported urodynamic changes after needle suspension procedures in terms of increased functional urethral length and improved pressure transmission to the proximal urethra. A 20-50% incidence of postoperative voiding difficulties has been reported in various studies. This publication reviews the controversies in the nomenclature of various needle suspension procedures, indication, suture materials, procedural details, and results of previously published needle suspension procedures and their modifications. Differences among commonly performed procedures are pointed out and analyzed for their role in the correction of stress urinary incontinence.