Skip to main content

Raz-Pereyra Trocar

The Raz-Pereyra trocar denotes a long retropubic suture carrier associated with the Pereyra and Raz needle-suspension family. Long-needle carriers can also deliver the suture arms of an autologous pubovaginal sling (PVS); the fascial graft itself remains suburethral. Instrument geometry, suture capture and reprocessing depend on the specific model. The related procedures have distinct historical and contemporary roles:

  • Historical: transvaginal needle bladder-neck suspension, including Pereyra, Stamey and Raz variants. A Cochrane review found worse continence than open retropubic colposuspension in small trials.[1][2][3]
  • Contemporary carrier role: autologous PVS for selected SUI patients, including some with prior failed surgery or reasons to avoid synthetic mesh. Stamey needles, or a larger instrument such as a Sarot, long tonsil or Kelly clamp, convey the graft's suture arms retropubically.[7]

Design​

  • Long rigid carrier suited to finger-guided retropubic passage. Length, curvature, tip and suture-loading mechanism must be checked against the actual model; a universal 25–30 cm/forked-tip specification is not established by the sources below.
  • Processing is model-specific. Confirm the manufacturer's current cleaning, sterilization and inspection instructions for the selected carrier. Cook Pereyra–Raz carriers J-RSN-901600 and 090002 were included in a 2017 Class II recall because their reprocessing instructions lacked sufficient detail; the FDA lists the recall as terminated in 2019.[10]

Contemporary Use — Autologous Rectus-Fascia Pubovaginal Sling​

One contemporary application for a long suture carrier is rectus-fascia PVS.[7] Graft site, dimensions, level and tensioning vary with anatomy and surgeon technique.[7]

  1. Harvest and prepare autologous fascia according to the chosen PVS technique; attach suture arms to the graft ends.
  2. Create the vaginal exposure and bilateral retropubic paths at the selected suburethral level.
  3. Pass the chosen long needle or carrier under continuous vaginal-finger guidance from the suprapubic incision through the retropubic space to the vaginal incision, one side at a time.
  4. Use the carrier's eyelet or other model-specific suture-loading feature to draw each graft suture arm, not the entire fascial strip, into the suprapubic field.[7]
  5. After both passes, perform cystoscopy to detect urinary-tract injury before final graft placement and tensioning.[7]
  6. Position and secure the graft without obstructive tension; sling level and fixation vary by technique.

The carrier creates a route for the suture arms; a Stamey needle or clamp is an explicitly described alternative.[7]

Why Autologous PVS Persists​

  • It is a non-mesh surgical option for selected patients after failed synthetic sling or with mesh complications, complex anatomy or a preference to avoid mesh.[7]
  • It has been used for SUI with intrinsic sphincter deficiency.[7] For SUI with a fixed, immobile urethra, the AUA/SUFU guideline lists pubovaginal slings among the options clinicians may offer, alongside retropubic midurethral slings, bulking agents and adjustable retropubic slings ; counsel about voiding dysfunction and other harms.[11]
  • In the SISTEr trial, 482 of 655 women (73.6%) entered an observational follow-up; incontinent women were more likely to enroll. The five-year continence endpoint required no leakage on a 3-day diary, no self-reported stress-incontinence symptoms, and no surgical retreatment. Continence was 30.8% after fascial sling versus 24.1% after Burch (p = 0.002 for the overall group difference). Satisfaction was higher after sling (83% versus 73%), adverse-event rates were similar, and continence fell substantially in both arms.[8]

See Female Stress Urinary Incontinence and the female-SUI surgical-techniques database for the broader treatment algorithm.

Historical Use — Transvaginal Needle Bladder-Neck Suspension​

The trocar's original 20th-century role. Three named operations defined the family:

OperationYearModifierAnchoring strategy
Pereyra1959Armand J. PereyraOriginal transvaginal needle suspension; suture from periurethral tissue to anterior abdominal fascia[4]
Stamey1973Thomas A. StameyCystoscopy-guided suture placement with Stamey needle modification[12]
Raz1981Shlomo RazBlunt endopelvic-fascia dissection; anchorage of periurethral fascia and pubourethral ligament; fixation over rectus muscle[1]

Mechanism. Indirect urethral support delivered through the vaginal walls (not directly to the urethra itself).[2] The needle pass through the retropubic space was blind; cystoscopy was used to verify no bladder injury.[2]

Historical Outcomes​

  • Overall subjective success approximately 85% (range 40–100%) across approximately 2,000 procedures in the early-literature pool, limited by subjective endpoint definitions and short follow-up.[3]
  • Recurrent SUI: one small, nonrandom series of 36 women reported 83% cure after Raz and 78% after Stamey.[5]
  • Postoperative voiding dysfunction in 20–50% across studies.[3]

Why the Needle Suspensions Fell Out of Favor​

  • Cochrane review (Glazener 2017). The review included ten small trials overall; seven contributed to the after-one-year comparison with open retropubic colposuspension, which found more subjective failures with needle suspension (91/313, 29% versus 47/297, 16%; RR 2.00, 95% CI 1.47 to 2.72). The authors judged the evidence limited by trial size and quality, and the sling comparisons inconclusive.[2]
  • JAMA scientific review (Holroyd-Leduc 2004). Identified open retropubic colposuspension and suburethral sling procedures as effective surgical treatments for stress incontinence.[6]
  • Modern MUS and other options. Replaced routine needle suspension, but this Cochrane comparison does not directly quantify needle suspension versus all MUS routes. UK NICE now explicitly advises not offering needle suspension for female SUI.[2][9]
  • Late failure. A higher late failure rate has been suggested for the modified Pereyra than for retropubic urethropexy.[4]

Needle bladder-neck suspension is now of primarily historical importance. Long carriers remain relevant to some autologous PVS techniques; the actual instrument choice is surgeon- and model-specific.[7][9]

Lineage — Pereyra, Raz, and the URPS Family​

  • Armand J. Pereyra (Long Beach) described the original 1959 needle bladder-neck suspension, the operation that gave the family its name and the trocar its original purpose.[4]
  • Shlomo Raz (UCLA) modified the needle-suspension technique; the Raz name also identifies a surgical lineage (see Surgical Genealogy).[1]

Contemporary Trocar vs Adjacent Instruments​

InstrumentBest fitStatus
Raz-Pereyra trocarHistorical Raz/Pereyra suspension; possible long-needle PVS carrierConfirm exact model, loading and IFU before use
Stamey needleEyelet-bearing suture carrier for historical Stamey suspension and described PVS techniquesInstrument remains applicable even though the named suspension is historical[7]
Midurethral sling trocars (TVT / TOT family)Mesh midurethral sling placementCurrent dominant SUI operation by volume
Capio suture-capturing deviceSacrospinous-ligament fixation and apical POP suspensionDifferent operative role

See also: Needle Suspensions and In Situ Slings (Historical), Female Urethra, The Retropubic Space, Stamey Needle, Midurethral Sling Trocars, Surgical Genealogy.

References​

1. Chopin D, Balladur A, Koury G, Abbou C, Auvert J. "Therapy of urinary stress incontinence by the Raz-Pereyra technic. Initial results." Rev Fr Gynecol Obstet. 1987;82(4):229–37. PMID 3589363

2. Glazener CM, Cooper K, Mashayekhi A. "Bladder neck needle suspension for urinary incontinence in women." Cochrane Database Syst Rev. 2017;7:CD003636. doi:10.1002/14651858.CD003636.pub4

3. Karram MM, Bhatia NN. "Transvaginal needle bladder neck suspension procedures for stress urinary incontinence: a comprehensive review." Obstet Gynecol. 1989;73(5 Pt 2):906–14. PMID 2649835

4. Cornella JL, Ostergard DR. "Needle suspension procedures for urinary stress incontinence: a review and historical perspective." Obstet Gynecol Surv. 1990;45(12):805–16. doi:10.1097/00006254-199012000-00001

5. Ramon J, Mekras J, Webster GD. "Transvaginal needle suspension procedures for recurrent stress incontinence." Urology. 1991;38(6):519–22. doi:10.1016/0090-4295(91)80168-7

6. Holroyd-Leduc JM, Straus SE. "Management of urinary incontinence in women: scientific review." JAMA. 2004;291(8):986–95. doi:10.1001/jama.291.8.986

7. Bailly GG, Carlson KV. The pubovaginal sling: reintroducing an old friend. Can Urol Assoc J. 2017;11(6 Suppl 2):S147–S151. doi:10.5489/cuaj.4611. Technical review (suture-arm passage with Stamey eyelets or clamp).

8. Brubaker L, Richter HE, Norton PA, et al. 5-year continence rates, satisfaction and adverse events of Burch urethropexy and fascial sling surgery for urinary incontinence. J Urol. 2012;187(4):1324–30. doi:10.1016/j.juro.2011.11.087

9. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management (NG123), Recommendations, recommendation 1.5.14 (accessed September 2026).

10. U.S. Food and Drug Administration. Class 2 Device Recall: Pereyra–Raz Ligature Carrier, Z-2534-2017. Initiated April 25, 2017; terminated March 26, 2019.

11. Kobashi KC, Vasavada S, Bloschichak A, et al. "Updates to surgical treatment of female stress urinary incontinence (SUI): AUA/SUFU guideline (2023)." J Urol. 2023;209(6):1091–1098. doi:10.1097/JU.0000000000003435

12. Stamey TA. "Endoscopic suspension of the vesical neck for urinary incontinence." Surg Gynecol Obstet. 1973;136(4):547–54. PMID: 4570309