Bone anchor 4-corner cystourethropexy: Long-term results

Purpose: We evaluate the long-terra results of incision less transvaginal bone anchor cystourethropexy to treat genuine urinary stress incontinence. Materials and Methods: Between August 1995 and January 1997, 31 women 36 to 81 years old (mean age 58) with types I and 11 genuine urinary stress incontinence were treated. Four miniature bone anchors (2 on each side of the urethra) attached to a suture were fired transvaginally into the retropubic bone using a bone anchor stapler. The ipsilateral sutures were tied, thus creating a Marshall-Marchetti colposuspension. Results: Of the patients 3 were lost to followup and the remaining 28 were followed for at least 60 months. Only 6 patients (21.4%) are continent. In 5 patients 11 sutures passed through the bladder 5 of which were removed intraoperatively and the other 6 were detected and removed during followup. Incontinence recurred in 1 patient because the sutures cut through the vaginal tissue and were found loose in the retropubic space. In 8 patients 12 anchors had become detached from the bone of which 7 were detected on x-ray in the retropubic area, 2 were removed cystoscopically 1 year later and 3 were spontaneously expulsed through the vagina 10 months to 5 years postoperatively. In 1 patient with intravesical sutures a vesicovaginal fistula developed which was successfully repaired, and in another pubic osteomyelitis developed. Conclusions: We regard 4-corner bone anchor cystourethropexy as unsuitable for genuine urinary stress incontinence based on the unfavorable outcome of incontinence and high rate of complications, including a relatively high incidence of confirmed anchor detachment.