A modified percutaneous outpatient bladder neck suspension system

During the last 8 years the original percutaneous needle suspension of Pereyra has been enhanced with the goal to reestablish safely and simply support of the pubocervical fascia in a reproducible and secure manner. Refinements include changes in points of suture attachment, limitation of suture tension and devices to perform the procedure simply and anchor the suspending suture in bone. A path along 2 planes of landmarks is used to guide the needle in capturing a maximum amount of mobile pubocervical fascia with a minimum risk of injury to the bladder or ureter. In 3 years over 150 patients have undergone this procedure. Early problems included suture breakage and inaccurate anchor placement. There have been no cases of chronic urinary retention. During the last 2 years the procedure has been performed on an outpatient basis. When suprapubic infection has been suspected, symptoms and signs have resolved with antibiotics. No sutures have been removed and osteitis pubis has not been noted. Any improvement in long-term durability has not yet been determined due to the history of ongoing refinements and the need for subsequent long-term followup. The specifics of this suspension system are described.