Endoscopic bladder neck suspension revisited: long-term results of Stamey and Gittes procedures.

Abstract

To evaluate the long-term results of Stamey's and Gittes' procedures for genuine stress incontinence. 72 needle procedures (34 Stamey; 38 Gittes) performed by a single surgeon between 1988 and 1994 were retrospectively reviewed. All patients had genuine stress incontinence on preoperative video-urodynamics. Review was at 3 months and thereafter clinically determined. Update information was gained by a patient satisfaction questionnaire. Data were available for 9 years for the Stamey group (mean 8.4 years) and 6 years for the Gittes' (mean 5.3 years). At 3 months, 93% were dry. There was a gradual attrition with 38% of the Stamey and 14% of the Gittes patients remaining dry or improved at 5 years. At 9 years, only 28% of the Stamey patients maintained their improvement. 26% of the original cohort underwent a second procedure. All patients who had repeat needle operations have failed. 48 questionnaires (67%) were returned. Only 25% of patients expressed satisfaction with their operation. Early success rates with endoscopic bladder neck suspension are replaced by long-term failures. The durability is poor with an ongoing recurrent incontinence rate. Repeat procedures are not worthwhile. Gittes' procedure appears to have an earlier failure rate compared to Stamey's operation.