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Meta-Analysis
. 2017 Jul 25;7(7):CD003636.
doi: 10.1002/14651858.CD003636.pub4.

Bladder neck needle suspension for urinary incontinence in women

Cathryn Ma Glazener  1 , Kevin Cooper, Atefeh Mashayekhi
Affiliations
Meta-Analysis

Bladder neck needle suspension for urinary incontinence in women

Cathryn Ma Glazener et al. Cochrane Database Syst Rev. .

Abstract

Background: 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.

Objectives: To determine the effects of needle suspension on stress or mixed urinary incontinence in comparison with other management options.

Search methods: 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.

Selection criteria: Randomised or quasi-randomised trials that included needle suspension for the treatment of urinary incontinence.

Data collection and analysis: At least two authors assessed trials and extracted data independently. Two trial investigators provided additional information.

Main results: 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.

Authors' conclusions: 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.

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Conflict of interest statement

Cathryn MA Glazener: None known

Kevin Cooper: None known

Atefeh Mashayekhi: This project, to add Brief Economic Commentaries to our 'Surgery for UI in women' reviews, was supported by the National Institute for Health Research (NIHR), via the Cochrane Review Incentive Scheme 2016, to the Cochrane Incontinence Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Figures

1.1
1.1. Analysis
Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
1.2
1.2. Analysis
Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.
1.3
1.3. Analysis
Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 3 Number not improved (worse or unchanged) within first year.
1.4
1.4. Analysis
Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 4 Number not improved (worse or unchanged) after first year.
1.5
1.5. Analysis
Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 5 Urge symptoms or urge incontinence.
1.6
1.6. Analysis
Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 6 Voiding dysfunction after 3 months.
1.7
1.7. Analysis
Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).
1.8
1.8. Analysis
Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 8 New or persistent prolapse.
1.9
1.9. Analysis
Comparison 1 Needle suspension versus open abdominal retropubic suspension, Outcome 9 Peri‐operative surgical complications.
2.1
2.1. Analysis
Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.
2.2
2.2. Analysis
Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.
2.3
2.3. Analysis
Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 3 Urge symptoms or urge incontinence.
2.4
2.4. Analysis
Comparison 2 Needle suspension versus open abdominal retropubic suspension (no previous surgery), Outcome 4 New or persistent prolapse.
3.1
3.1. Analysis
Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 1 Number not cured (worse, unchanged or improved) within first year.
3.2
3.2. Analysis
Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 2 Number not cured (worse, unchanged or improved) after first year.
3.3
3.3. Analysis
Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 3 Number not improved (worse or unchanged) within first year.
3.4
3.4. Analysis
Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 4 Number not improved (worse or unchanged) after first year.
3.5
3.5. Analysis
Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 5 Urge symptoms or urge incontinence.
3.6
3.6. Analysis
Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 6 Voiding dysfunction after 3 months.
3.7
3.7. Analysis
Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 7 Detrusor overactivity (objective diagnosis by urodynamics).
3.8
3.8. Analysis
Comparison 3 Needle suspension versus open abdominal retropubic suspension (mixed population, some after previous surgery), Outcome 8 Peri‐operative surgical complications.
4.1
4.1. Analysis
Comparison 4 Needle suspension versus suburethral sling operations, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
4.2
4.2. Analysis
Comparison 4 Needle suspension versus suburethral sling operations, Outcome 2 Number not cured (worse, unchanged or improved) after first year.
4.3
4.3. Analysis
Comparison 4 Needle suspension versus suburethral sling operations, Outcome 3 Urge symptoms or urge incontinence.
4.4
4.4. Analysis
Comparison 4 Needle suspension versus suburethral sling operations, Outcome 4 Voiding dysfunction after 3 months.
4.5
4.5. Analysis
Comparison 4 Needle suspension versus suburethral sling operations, Outcome 5 Detrusor overactivity (objective diagnosis by urodynamics).
4.6
4.6. Analysis
Comparison 4 Needle suspension versus suburethral sling operations, Outcome 6 Peri‐operative surgical complications.
4.7
4.7. Analysis
Comparison 4 Needle suspension versus suburethral sling operations, Outcome 7 Length of inpatient stay.
5.1
5.1. Analysis
Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
5.2
5.2. Analysis
Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 2 Number not cured (worse, unchanged or improved) after first year.
5.3
5.3. Analysis
Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 3 Urge symptoms or urge incontinence.
5.4
5.4. Analysis
Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 4 Voiding dysfunction after 3 months.
5.5
5.5. Analysis
Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 5 Peri‐operative surgical complications.
5.6
5.6. Analysis
Comparison 5 Needle suspension versus anterior vaginal repair, Outcome 6 New or persistent prolapse.
6.1
6.1. Analysis
Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
6.2
6.2. Analysis
Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 2 Number not cured (worse, unchanged or improved) after first year.
6.3
6.3. Analysis
Comparison 6 One type of needle suspension versus another type of needle suspension, Outcome 3 Urge symptoms or urge incontinence.
7.1
7.1. Analysis
Comparison 7 One type of suture versus another type of suture, Outcome 1 Number not cured (worse, unchanged or improved) within first year.
7.2
7.2. Analysis
Comparison 7 One type of suture versus another type of suture, Outcome 2 Number not improved (worse or unchanged) within first year.
7.3
7.3. Analysis
Comparison 7 One type of suture versus another type of suture, Outcome 3 Urge symptoms or urge incontinence.
7.4
7.4. Analysis
Comparison 7 One type of suture versus another type of suture, Outcome 4 Pain score.
See this image and copyright information in PMC

Update of

References

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Bump 1995 {published data only}
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