Percutaneous Bladder Neck Suspension using Bone Anchors for the Treatment of Stress Urinary Incontinence

Rho, Chang Wan; Lee, You Sik

Abstract

PURPOSE: We investigated the technical feasibility and clinical results of percutaneous bladder neck suspension(PBNS) using bone anchors(Vesica) which represents a minimally invasive surgical procedure for the treatment of stress urinary incontinence caused by hypermobility of the proximal urethra and bladder neck.
MATERIALS AND METHODS
Among women who underwent PBNS using bone anchors for type I or type II stress urinary incontinence, 22 women were followed for at least postoperative 9 months. A miniature bone anchor was used. On each side the suture was attached to the pubocervical fascia and the vaginal wall via a broad ?Z-stitch?. Postoperative voiding status was evaluated during office follow-up visits and telephone surveys.
RESULTS
Mean operation time was 32 minutes. Mean hospital stay was 0.9 days. Mean follow-up was 13 months(9 to 18 months). In the 22 patients, the procedure was successful in 18 cases(82%), with 11(50%) of the patients completely dry and 7(32%) significantly improved. Preoperative urgency was present in 10 patients(45%). Postoperative resolution rate of urgency was 60%(6 of 10 patients). In 4 cases(18%), de novo urgency was documented. Removal of the bone anchor and suture was necessary in only one patient, because of persistent vaginal infection. Other complications were transient urinary retention in 3 patients(14%), prolonged suprapubic discomfort in 1 patient(4.5%) and incidental bladder perforation in 1 patient(4.5%). Major complications such as chronic urinary retention, osteitis pubis were not noted.
CONCLUSIONS
The use of this bone anchoring technique and preservation of the endopelvic fascia appears to enhance the success rate without increasing the risk to the patient and, as minimally invasive procedures, reduce the surgery time and the length of hospitalization. However, the suspension sutures of PBNS may pull through the paraurethral tissue because there is no paravesical scar formation as in open procedures. Therefore we conclude that modifications of the suspension technique should be required for the improvement of long-term results.