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Long-needle bladder neck suspension for genuine stress incontinence--does endoscopy influence results? A structured
1Department of Urogynaecology, St James's University Hospital, Leeds, UK.
Objective:
To assess the hypothesis that the use of an endoscope to aid suture placement in long-needle suspension procedures is more likely to be lead to improved results.
Materials And Methods:
A literature survey of 15 journals yielded 77 evaluable publications which provided data to compare the subjective and objective outcomes following a Pereyra procedure (2259 and 301 patients, respectively) or a Stamey procedure (2029 and 456 patients, respectively).
Results:
There was no statistically significant difference in the mean percentage continence rates, based on subjective assessment of continence, following either the Pereyra or the Stamey procedure. Approximately 7% of patients subjectively claimed to be continent yet were not so upon some form of objective measurement.
Conclusion:
The analysis detected no improvement in the likelihood of continence after long-needle suspension procedures whether or not they were performed under endoscopic control to aid suture placement. This conclusion applied to primary procedures whether outcome was judged subjectively or objectively, and to subjective outcome after previously failed surgery. This study suggests that those surgeons who report their results are sufficiently skilled in judging suture placement as accurately as is needed without the benefit of a cystoscope.