Where is the bladder neck following needle suspension operations?

Bladder neck suspension operations are commonly performed for stress incontinence. Cure is achieved by increasing proximal urethral pressure by repositioning the bladder neck in a supported retropubic position. A prospective study of 25 consecutive cases assessed the position of the bladder neck radiologically pre- and postoperatively and correlated this with the symptomatic cure or failure of surgery. The final position of the bladder neck relative to the inferior border of the symphysis pubis showed no correlation with the symptomatic outcome. Three cases of "failed" surgery showed greater elevation of the bladder neck than that achieved in women enjoying symptomatic cure, suggesting that the absolute amount of elevation achieved may not be of paramount importance. This report suggests that continence after surgery is not solely related to the anatomical position of the bladder neck relative to the sacral plane, but is more likely due to increased proximal urethral pressure during stress.