Background
Stress urinary incontinence is loss of urine when coughing, laughing, sneezing or exercising. Damage to the muscles that hold up the bladder may cause it. About a third of adult women may have urine leakage, and about a third of these may have problems bad enough to require surgery. A significant amount of a woman's and their family's income can be spent on management of stress urinary incontinence.
When non-surgical methods, such as exercising the muscles in the pelvic floor (the base of the abdomen) or drugs, have not worked surgery is sometimes used to lift and support the neck of the bladder to help stop urine leaking. Needle suspension involves tying sutures between the vagina and the abdominal wall.
Study characteristics
The review found 10 trials, which studied 375 women having six different types of needle suspension operations and compared them with 489 women who received other treatments. Most of the trials were small or of poor quality, making their results less reliable.
Key results
More women were cured after abdominal operations such as colposuspension (84%) than after needle suspension (71%): both women who had and had not had a previous operation for incontinence. There was not enough evidence about complications, or how needle suspension compares with other operations. Needle suspension operations were not compared with conservative treatments such as pelvic floor exercises or drugs. In summary, needle suspension surgery appears to be less effective for urinary incontinence than abdominal surgery, and there is not enough evidence to compare it to other treatments.
Bladder neck needle suspension surgery is probably not as good as open abdominal retropubic suspension for the treatment of primary and secondary urodynamic stress incontinence because the cure rates were lower in the trials reviewed. However, the reliability of the evidence was limited by poor quality and small trials. There was not enough information to comment on comparisons with suburethral sling operations. Although cure rates were similar after needle suspension compared with after anterior vaginal repair, the data were insufficient to be reliable and inadequate to compare morbidity. A Brief Economic Commentary (BEC) identified no cost-effectiveness studies comparing bladder neck needle suspension with other surgeries.
Bladder neck needle suspension is an operation traditionally used for moderate or severe stress urinary incontinence in women. About a third of adult women experience some urinary incontinence, and about a third of these have moderate or severe symptoms. Stress urinary incontinence (SUI) imposes significant health and economic burdens on society and the women affected.
To determine the effects of needle suspension on stress or mixed urinary incontinence in comparison with other management options.
We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 12 November 2014), and the reference lists of relevant articles.
Randomised or quasi-randomised trials that included needle suspension for the treatment of urinary incontinence.
At least two authors assessed trials and extracted data independently. Two trial investigators provided additional information.
We identified 10 trials, which included 375 women having six different types of needle suspension procedures and 489 who received comparison interventions. Needle suspensions were more likely to fail than open abdominal retropubic suspension. There was a higher subjective failure rate after the first year (91/313 (29%) failed versus 47/297 (16%) failed after open abdominal retropubic suspension). The risk ratio (RR) was 2.00 (95% confidence interval (CI) 1.47 to 2.72), although the difference in peri-operative complications was not significant (17/75 (23%) versus 12/77 (16%); RR 1.44, 95% CI 0.73 to 2.83). There were no significant differences for the other outcome measures. This effect was seen in both women with primary incontinence and women with recurrent incontinence after failed primary operations. Needle suspensions may be as effective as anterior vaginal repair (50/156 (32%) failed after needle suspension versus 64/181 (35%) after anterior repair; RR 0.86, 95% CI 0.64 to 1.16), but there was little information about morbidity. Data for comparison with suburethral slings were inconclusive because they came from a small and atypical population.
No trials compared needle suspensions with conservative management, peri-urethral injections, or sham or laparoscopic surgery.