The use of bone anchoring in the surgical management of female stress urinary incontinence.

Recent reviews have noted failures of transvaginal surgical procedures designed to cure female stress urinary incontinence (SUI). Modifications continue to be applied to improve the transvaginal approach, including anchoring of the supporting sutures to the pelvic bones, reduction of the transvaginal dissection to help reduce further prolapse, and simpler techniques to allow a wider use of sling procedures. This paper reports on the use of a bone-anchoring technique and preservation of the endopelvic fascia in both transvaginal suspension surgery for hypermobility and sling surgery for intrinsic sphincteric deficiency. Results show an 81.7% cure rate in 71 patients who underwent the bone-anchor suspension and were followed for at least 3 years; a 97.5% cure rate in 40 patients who underwent an in situ sling procedure with bone anchoring and were followed for at least 2 years; and a 94% cure rate in 78 patients who underwent a sling procedure with autologous or synthetic material and bone anchoring and were followed for at least 2 years. 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, thus reducing costs.