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Needle Suspensions and In Situ Slings (Historical)

Transvaginal needle bladder-neck suspensions are operations for female stress urinary incontinence (SUI) in which a long needle or ligature carrier passes sutures blindly through the retropubic space, from the paraurethral tissue on each side of the bladder neck to the anterior abdominal wall. The urethra is supported indirectly through the vaginal wall, and cystoscopy is used to look for bladder injury.[1] Pereyra described the first in 1959. Stamey, Raz, Gittes and Loughlin, Leach and Benderev modified it over the next three decades, and Raz used the same carrier technique in 1989 to suspend an island of anterior vaginal wall as an in situ sling.[2][3][4][5][6][7] In randomized trials, needle suspensions failed more often than open retropubic suspension after the first postoperative year, and NICE now advises against offering needle suspension for SUI.[1][8]

The operations remain relevant to reconstructive surgeons because they produced recurrent SUI, outlet obstruction, groin pain and infection of sutures, bolsters and bone anchors, and because multiple prior suspensions were a common antecedent of intrinsic sphincter dysfunction in referral series of the period.[9][10][11][12] The open retropubic family, the Marshall–Marchetti–Krantz operation and Burch colposuspension, is covered on its own pages and is not repeated here.

Shared Rationale and Anatomy​

The operations shared one hypothesis: continence is restored by returning a descended bladder neck to a high position behind the symphysis pubis. Stamey stated this premise in his 1980 report, and Schaeffer and Stamey described the endoscopic suspension as elevating the internal vesical neck on each side with two buttressed nylon loops.[13][14]

A cadaver and autopsy study of needle suspension found that the dissection plane runs between the vaginal mucosa and the visceral endopelvic fascia. The retropubic space is entered lateral to the arcus tendineus fasciae pelvis, the paraurethral vascular plexus and the bladder neck, cephalad to the perineal membrane. The suspensory suture incorporates the endopelvic fascia between vagina and urethra and usually the arcus tendineus, and appears to stabilize the bladder neck by giving its supporting fascia a new point of lateral fixation.[15]

Pereyra attributed failure of urethral suspensory operations to pull-out of sutures attached to attenuated endopelvic fascia around the urethrovesical junction.[16] Most later modifications addressed the same weak point: buttresses or bolsters at the vaginal end, broader or full-thickness tissue bites, and fixation to the pubic bone rather than the rectus fascia.[13][4][6] In a 20-patient series of one such modification, every failure occurred in an obese patient and involved apparent suture pull-through.[17]

The Operations​

OperationFirst reportDistinguishing featureBasis for the description
Pereyra1959Transvaginal suspension without abdominal retropubic dissectionIndexed record only; later reviews[2][18]
Modified Pereyra1967, 1982Endopelvic fascia detached from the pubis and enfolded, bound with the posterior pubourethral ligaments in the suspensory suture1982 abstract[16]
Stamey endoscopic suspension1973No. 2 monofilament nylon, vaginal Dacron buttress, endoscopic visualization of the vesical neck during suspension1980 and 1984 reports[19][13][14]
Raz (UCLA "modified Pereyra")1981Transvaginal mobilization of the urethra and anterior vaginal wall before suspension1984 report[20][21]
Gittes–Loughlin1987No incisions; full-thickness vaginal mattress sutures with the knot buried suprapubically1987 abstract[4]
Bone-anchored suspension1988 onwardSuspension sutures fixed to the pubic tubercle or to a pubic bone anchor1988, 1992, 1994 and 1996 abstracts[5][6][22][23]
Raz vaginal wall (in situ) sling1989Island of anterior vaginal wall suspended at four corners; compression and support1989 abstract[7]
Ingelman-Sundberg pubococcygeal repair1947Extravaginal pelvic-floor repair for bladder-neck descentIndexed record only; later series[24][25]

Karram and Bhatia's 1989 review noted inconsistent nomenclature across the family and identified the modified Pereyra procedure with gynecologic surgeons and the Stamey and Raz procedures with urologic surgeons.[3]

Pereyra Suspension (1959) and the Modified Pereyra (1982)​

Pereyra's 1959 report has no indexed abstract.[2] Cornella and Ostergard's historical review credits it with a new approach to SUI that did not require abdominal retropubic dissection, and treats Pereyra's own later modifications as the foundation of the needle-suspension family.[18] Pereyra and Lebherz reported a combined urethrovesical suspension and vaginourethroplasty in 1967.[26]

The 1982 modified Pereyra procedure detached the endopelvic fascia from the inferior pubis so that it could be enfolded and thickened. This exposed the posterior pubourethral ligaments, which were bound together with the enfolded fascia in the suspensory sutures to resist pull-out. Of 54 women operated on for primary anatomic SUI, 94.5% were reported cured or markedly improved at 4 to 6 years.[16]

Stamey Endoscopic Suspension (1973)​

Stamey's 1973 description has no indexed abstract.[19] His 1980 report of 203 women (211 operations) lists the technical features: heavy No. 2 monofilament nylon, a vaginally placed Dacron buttress to prevent tearing of the pubocervical fascia, and endoscopic visualization of the restored vesical neck during the operation. The cohort was selected toward difficult cases: 188 previous continence operations, including 74 Marshall–Marchetti repairs, and only 20% with typical cough or sneeze stress leakage. A 91% cure rate was reported with a minimum follow-up of six months; 47 women had been followed for more than four years.[13] Instrument detail and the long-term Stamey series are on the Stamey needle page.

Raz Modification (1981)​

Raz's 1981 description has no indexed abstract.[20] Leach and Raz's 1984 report describes the operation as transvaginal mobilization of the urethra and anterior vaginal wall followed by a modified Pereyra bladder-neck suspension. In 54 women with persistent or recurrent SUI after one to nine failed operations, a 94% cure rate was reported at a minimum follow-up of 24 months.[21] Leach and Philippe Zimmern published a technical description of the modified Pereyra–Raz suspension in 1991, and the UCLA-trained group continued to report the operation as the modified Pereyra procedure.[27][28] Shlomo Raz also described a four-corner transvaginal needle suspension that supported the bladder base and repositioned the bladder neck in women with moderate cystocele.[29] A single-surgeon randomized study of 146 women reported continence at three years in 89.3% after Burch, 80.4% after the Raz suspension and 86.4% after a "transvaginal Burch" that fixed the Raz sutures to the iliopectineal ligament.[30]

Gittes–Loughlin No-Incision Suspension (1987)​

Gittes and Loughlin eliminated every incision. Two heavy nonabsorbable monofilament mattress sutures were passed down through and back up through the full thickness of the anterior vaginal wall and tied suprapubically, so that the knot was buried in the fat of the suprapubic puncture. The technique rested on their animal observation that mattress sutures tied under tension around skin cut through, became internalized and were accepted without residual inflammation if the knot was buried. The procedure was done as outpatient surgery and in selected patients under local anesthesia. The authors reported continence above 87% in their first 38 patients at 2.5 years.[4] Later series did not reproduce this durability (see the outcomes table).[31][32]

Bone-Anchored and Percutaneous Suspensions (1988 to the Late 1990s)​

Gary Leach fixed the suprapubic ends of the suspension sutures to the pubic tubercle rather than the anterior abdominal wall. In 115 women over two years he reported less postoperative discomfort and no need for synthetic material.[5] Benderev combined three changes in 53 consecutive women: a needle path designed to capture as much urethropelvic fascia lateral to the bladder neck as possible while avoiding the bladder, pubic fixation with a small orthopedic bone anchor, and a method to limit suture tension. He reported four failures with follow-up of up to 15 months and stated that the effect on long-term efficacy would require continued follow-up.[6] His later percutaneous system had been used in more than 150 patients; early problems included suture breakage and inaccurate anchor placement.[22]

The Vesica percutaneous bladder-neck stabilization combined a pubic bone anchor, a full-thickness Z suture through the endopelvic, pubocervical and subvaginal fascia and the vaginal wall, loose resuspension of the proximal urethra, and cystoscopic verification of suture position. Appell and colleagues reported 94% cure at 12 months in 71 women, with one retropubic abscess and one skin sinus from an infected anchor.[23] Longer follow-up of bone-anchored needle suspension was poor (see the outcomes table).[33][34]

Raz Vaginal Wall Sling (1989)​

The vaginal wall sling, later called the in situ anterior vaginal wall sling, was described by Raz and colleagues for incontinence due to intrinsic sphincteric damage. A rectangular island of in situ anterior vaginal wall beneath the urethra and bladder neck was developed and its four corners were anchored with polypropylene sutures. A ligature carrier transferred the sutures suprapubically, and an anterior vaginal wall flap proximal to the island was advanced to cover it. When tied, the island supported the urethra and increased urethral resistance by compression. Continence was reported in 29 of 32 women; all voided spontaneously except those with neuropathic urethral incompetence, who used self-catheterization.[7] The covering flap distinguishes it from a needle suspension: the support is a strip of the patient's own vaginal wall rather than paraurethral suture bites.

Juma, Little and Raz reported 65 women treated from 1985, 54 with follow-up; in 48 of the 54, intrinsic sphincter dysfunction was attributed to multiple prior bladder-neck suspensions. Success for stress incontinence was 94.4% at a mean of 23.9 months. Temporary retention occurred in 83%, and 5.5% needed long-term intermittent self-catheterization (excluding neurogenic bladder and augmentation). De novo detrusor instability developed in 14.8%, and no vaginal inclusion cyst was seen.[12] Later series are summarized in the outcomes table; their results varied with follow-up, outcome definition and leak-point pressure.[35][36][37][38]

Ingelman-Sundberg Operations (1947 and 1959)​

Axel Ingelman-Sundberg described an extravaginal plastic repair of the pelvic floor for bladder-neck descent in 1947. The indexed record has no abstract, and the operative steps were not verified for this page.[24] Later literature calls it the pubococcygeal repair. Öbrink examined 51 women operated on between 1955 and 1965, each with at least 10 years of observation. The symptomatic cure rate was 84% and the technical cure rate 75%; most severe recurrences appeared in the first year, and the only long-term side effect was a tendency to rectocele. This is a single-center retrospective series.[25]

His 1959 partial bladder denervation addressed urge incontinence, not SUI.[39] Hodgkinson and Drukker describe the original operation as transection of the preganglionic pelvic nerves near the inferior surface of the bladder, dividing both sympathetic and parasympathetic fibers.[40] In 1975 Ingelman-Sundberg described unilateral or bilateral resection of the inferior hypogastric plexus for uninhibited or hypertonic neurogenic bladders and interstitial cystitis, when preoperative local-anesthetic blockade had given a favorable result.[41] Edward McGuire's group revived a modified transvaginal version, offered to women with refractory urge incontinence that resolved temporarily after a transvaginal local-anesthetic block of the terminal pelvic-nerve branches. In 25 women, 64% were cured of urge incontinence at a mean of 14.8 months, with operating time of about 15 minutes.[42] A second series of 28 women from the same group, selected by response to a subtrigonal bupivacaine injection and treated with dissection of the perivesical fascia from the trigone and sharp division of terminal pelvic-nerve branches, reported durable resolution in 54%, improvement in 14% and no change in 32% at a mean of 44.1 months.[43] Current treatment of refractory urgency incontinence is covered in the OAB and urgency incontinence database.

Outcomes and Abandonment​

Early pooled results overstated durability. Karram and Bhatia found an overall success rate of 85% (range 40–100%) across 1,967 reported needle suspensions, but most studies used subjective cure, few had long-term follow-up and postoperative voiding difficulty was reported in 20–50%.[3] Series with longer follow-up and stricter endpoints showed progressive failure.

StudyDesignResultLimits
Glazener 2017 (Cochrane)10 randomized or quasi-randomized trials; 375 needle suspensions, 489 comparatorsVersus open retropubic suspension: failure RR 1.70 (95% CI 1.11–2.60) within the first year (5 trials, 517 women) and 91/313 (29%) vs 47/297 (16%), RR 2.00 (1.47–2.72), after the first year. Perioperative complications 23% vs 16% (RR 1.44, 0.73–2.83). Versus anterior repair: 32% vs 35% failure (RR 0.86)Small, poor-quality trials; only one 20-woman sling comparison (inconclusive); search date November 2014[1]
Bergman and Elia 1995Randomized, single center; 127 women, 93 at 5 years; primary SUIObjective success at 5 years: Burch 82%, modified Pereyra 43%, Kelly plication 37%; fall over 4 years 7%, 22% and 26%Cochrane extraction gives 5-year failure of 17/30 (57%) after needle suspension vs 6/33 (18%) after Burch[44][1]
Kondo 1998Nonrandomized; Stamey 342, Gittes 40; questionnaireKaplan–Meier continence 71.5% at 14 years (Stamey) vs 37.0% at 6 years (Gittes); McGuire type III 38.3% at 10 years; de novo urge incontinence 12%Mean follow-up 8.1 and 5.0 years[31]
Elkabir and Mee 1998Single surgeon; Gittes; postal questionnaire, 52 of 87 women responded23.1% cured at mean 53 months; 80% of those not cured leaked again within 2 years60% response[32]
Trockman 1995Single center; modified Pereyra; survey of 125 of 177 womenAt mean 9.8 years, 20% reported no incontinence and 51% SUI with or without urge incontinence; 71% reported significant improvement and 73% satisfactionMethod and length of follow-up changed the reported continence rate[28]
Tebyani 2000Single center, retrospective; percutaneous needle suspension with bone anchors; telephone survey of 42 of 49At mean 29 months: cure 5%, significant improvement 12%, failure 83%; 2 anchors migrated into the pelvis; 1 osteomyelitis needing debridementSubjective endpoints; no prior continence surgery[33]
Reid and Parys 2005Single center; Vesica; 40 womenDry 85% at 6 months and 46% at 12 months; continence 31% at 5 years; wound infection 16%Fraying of the suspensory sutures at the anchor at reoperation[34]
Raz 1996Prospective cohort; vaginal wall sling; 160 women (95 ISD, 65 anatomical)Failure 7%; de novo urge incontinence 9%; no difference in time to failure between groupsFollow-up duration not stated in the abstract[35]
Kaplan 2000Prospective cohort; vaginal wall sling; 373 womenRecurrent SUI 4% at mean 39.8 months; de novo detrusor overactivity or urge incontinence 8%; prolapse 7%Single institution[36]
Goldman 2001Retrospective; in situ vaginal wall sling; 39 evaluable79.5% success at mean 19 months; 93% with Valsalva leak-point pressure ≥50 cm H₂O vs 40% below 50Chart review and telephone interview[37]
Illiano 2022Prospective, single center; in situ sling reinforced with Marlex mesh rolls; 40 women, 20 seen at median 20.9 yearsSuccess 80% at 5 years; objective cure 45% beyond 5 years (38% in pure SUI)Mesh-reinforced variant, not the original mesh-free sling[38]

The American Urological Association's 1997 female SUI guidelines panel (summary report first-authored by Leach) meta-analyzed the literature through 1993. It concluded that after 48 months retropubic suspensions and slings appeared more efficacious than transvaginal suspensions and anterior repairs, while judging that retropubic and sling operations carried slightly higher complication rates, longer convalescence and more voiding dysfunction.[45] The Cochrane review reached the same conclusion on cure from randomized data.[1] A 2013 RAND/UCLA expert panel adopted a quality indicator that a woman should not undergo Kelly plication, anterior colporrhaphy or needle suspension for SUI.[46] NICE NG123 lists needle suspension among procedures not to be offered for SUI, with anterior colporrhaphy, paravaginal defect repair, porcine dermis slings and the Marshall–Marchetti–Krantz procedure.[8] The randomized trials that later positioned Burch, the autologous fascial sling and the midurethral sling (SISTEr and the UK and Ireland TVT trial) are covered on the Burch, pubovaginal sling and retropubic midurethral sling pages.

Complications Still Seen​

  • Voiding dysfunction and obstruction. Postoperative voiding difficulty was reported in 20–50% of needle suspensions.[3] In McGuire's 1989 urethrolysis series, 4 of 13 obstructed women had obstruction after needle suspension.[9]
  • Ilioinguinal nerve entrapment. The nerve lies almost directly above the pubic tubercle near its exit from the superficial inguinal ring. Miyazaki and Shook encountered seven cases over 27 months, each diagnosed by characteristic pain in the medial groin, mons, labia majora and inner thigh; Monga and Ghoniem described two further cases with diagnosis, management and prevention.[10][47]
  • Suture, buttress and bolster infection. The Cochrane review's perioperative complications included stitch removal for pain and removal of an infected Dacron sheath. In a comparison of 30 Stamey and 17 Pereyra–Raz operations, 5 buffer infections occurred and 3 buffers were removed.[1][48] Late foreign-body complications of the Stamey bolster are described on the Stamey needle page.
  • Bone-anchor infection. A literature review of bone-anchor procedures from 1990 to 2000 found infectious osseous complications in 6 of 1,018 procedures (0.6%), all with suprapubic anchors (6 of 698), presenting between weeks 1 and 24; reported organisms suggested a coliform, skin or hematogenous source.[49] In a two-center telephone and chart follow-up of 225 women after suprapubic bone-anchored bladder-neck suspension, 3 (1.3%) developed pubic osteomyelitis; each required laparotomy, anchor removal, bone debridement and prolonged parenteral antibiotics.[11] For transvaginal anchors used in cadaveric-fascia slings and prolapse repair, Leach's group combined its series with published series and reported osteitis pubis in 0.16% and osteomyelitis in 0.08% of 1,228 patients, lower than previously reported for suprapubic anchors.[50] Anchor dislodgement and migration into the pelvis has also been reported.[33]
  • De novo urgency. De novo urge incontinence was 12% after Stamey or Gittes suspension and 9% to 14.8% after the vaginal wall sling.[31][35][12]

Managing These Patients Today​

Women with a remote needle suspension, bone-anchored suspension or in situ sling are assessed as any recurrent or complicated SUI case: stress leakage, urethral mobility, sphincter function, urgency, emptying and the retropubic and vaginal tissue left by the earlier operation. In the bone-anchored series that studied failures urodynamically, 16 of 18 evaluated women had recurrent urethral hypermobility, whereas in a referral series treated with the vaginal wall sling, intrinsic sphincter dysfunction was attributed to multiple prior suspensions in 48 of 54 women.[33][12] Women with McGuire type III incontinence did poorly after Stamey or Gittes suspension.[31]

  • Recurrent SUI. See the female SUI database for current options and the autologous pubovaginal sling page for carrier passage through a scarred retropubic space. Repeat needle suspension is not a current option.[8]
  • Obstruction after suspension. See urethrolysis.
  • Suprapubic pain, wound sinus or pubic tenderness after a bone anchor. Consider anchor infection or osteomyelitis; the reported cases were managed with anchor removal, debridement and prolonged antibiotics.[11][33]
  • Medial groin, mons or labial pain in the distribution of the ilioinguinal nerve after suspension suggests entrapment.[10][47]

Evidence Gaps​

The original Pereyra, Stamey, Raz and Ingelman-Sundberg descriptions have no indexed abstracts, so technique detail on this page depends on the authors' later reports. The randomized trials of needle suspension are small and of poor quality, and the subtypes were compared directly in only one trial.[1] The vaginal wall sling and partial denervation series are single-center cohorts without randomized comparators, with outcome definitions and follow-up that differ from series to series.

See Also​

References​

1. Glazener CMA, 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. Full text.

2. Pereyra AJ. A simplified surgical procedure for the correction of stress incontinence in women. West J Surg Obstet Gynecol. 1959;67(4):223-226. PMID 13676490. Indexed record only (no abstract).

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):906-914. PMID 2649835.

4. Gittes RF, Loughlin KR. No-incision pubovaginal suspension for stress incontinence. J Urol. 1987;138(3):568-570. doi:10.1016/s0022-5347(17)43261-7.

5. Leach GE. Bone fixation technique for transvaginal needle suspension. Urology. 1988;31(5):388-390. doi:10.1016/0090-4295(88)90731-5.

6. Benderev TV. Anchor fixation and other modifications of endoscopic bladder neck suspension. Urology. 1992;40(5):409-418. doi:10.1016/0090-4295(92)90453-4.

7. Raz S, Siegel AL, Short JL, Snyder JA. Vaginal wall sling. J Urol. 1989;141(1):43-46. doi:10.1016/s0022-5347(17)40581-7.

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

9. McGuire EJ, Letson W, Wang S. Transvaginal urethrolysis after obstructive urethral suspension procedures. J Urol. 1989;142(4):1037-1039. doi:10.1016/s0022-5347(17)38980-2.

10. Miyazaki F, Shook G. Ilioinguinal nerve entrapment during needle suspension for stress incontinence. Obstet Gynecol. 1992;80(2):246-248. PMID 1635738.

11. Goldberg RP, Tchetgen MB, Sand PK, et al. Incidence of pubic osteomyelitis after bladder neck suspension using bone anchors. Urology. 2004;63(4):704-708. doi:10.1016/j.urology.2003.11.013.

12. Juma S, Little NA, Raz S. Vaginal wall sling: four years later. Urology. 1992;39(5):424-428. doi:10.1016/0090-4295(92)90238-r.

13. Stamey TA. Endoscopic suspension of the vesical neck for urinary incontinence in females: report on 203 consecutive patients. Ann Surg. 1980;192(4):465-471. doi:10.1097/00000658-198010000-00005.

14. Schaeffer AJ, Stamey TA. Endoscopic suspension of vesical neck for urinary incontinence. Urology. 1984;23(5):484-494. doi:10.1016/s0090-4295(84)80012-6.

15. Fitzpatrick CC, Elkins TE, DeLancey JO. The surgical anatomy of needle bladder neck suspension. Obstet Gynecol. 1996;87(1):44-49. doi:10.1016/0029-7844(95)00355-x.

16. Pereyra AJ, Lebherz TB, Growdon WA, Powers JA. Pubourethral supports in perspective: modified Pereyra procedure for urinary incontinence. Obstet Gynecol. 1982;59(5):643-648. PMID 7041024.

17. Varner RE. Retropubic long-needle suspension procedures for stress urinary incontinence. Am J Obstet Gynecol. 1990;163(2):551-557. doi:10.1016/0002-9378(90)91196-j.

18. Cornella JL, Ostergard DR. Needle suspension procedures for urinary stress incontinence: a review and historical perspective. Obstet Gynecol Surv. 1990;45(12):805-816. doi:10.1097/00006254-199012000-00001.

19. Stamey TA. Endoscopic suspension of the vesical neck for urinary incontinence. Surg Gynecol Obstet. 1973;136(4):547-554. PMID 4570309. Indexed record only (no abstract).

20. Raz S. Modified bladder neck suspension for female stress incontinence. Urology. 1981;17(1):82-85. doi:10.1016/0090-4295(81)90021-2. Indexed record only (no abstract).

21. Leach GE, Raz S. Modified Pereyra bladder neck suspension after previously failed anti-incontinence surgery: surgical technique and results with long-term follow-up. Urology. 1984;23(4):359-362. doi:10.1016/0090-4295(84)90140-7.

22. Benderev TV. A modified percutaneous outpatient bladder neck suspension system. J Urol. 1994;152(6 Pt 2):2316-2320. doi:10.1016/s0022-5347(17)31666-x.

23. Appell RA, Rackley RR, Dmochowski RR. Vesica percutaneous bladder neck stabilization. J Endourol. 1996;10(3):221-225. doi:10.1089/end.1996.10.221.

24. Ingelman-Sundberg A. Extravaginal plastic repair of the pelvic floor for prolapse of the bladder neck; a new method to operate for stress incontinence. Gynaecologia. 1947;123(4):242-254. doi:10.1159/000312257. Indexed record only (no abstract).

25. Öbrink A. Pubococcygeal repair ad modum Ingelman-Sundberg: a retrospective investigation with 10-20 years time of observation. Acta Obstet Gynecol Scand. 1977;56(4):391-397. doi:10.3109/00016347709154999.

26. Pereyra AJ, Lebherz TB. Combined urethrovesical suspension and vaginourethroplasty for correction of urinary stress incontinence. Obstet Gynecol. 1967;30(4):537-546. PMID 6042890.

27. Zimmern PE, Leach G. [Bladder neck suspension using the modified Pereyra-Raz procedure in the treatment of stress urinary incontinence in women]. J Urol (Paris). 1991;97(7-8):309-319. PMID 1811023. In French.

28. Trockman BA, Leach GE, Hamilton J, Sakamoto M, Santiago L, Zimmern PE. Modified Pereyra bladder neck suspension: 10-year mean followup using outcomes analysis in 125 patients. J Urol. 1995;154(5):1841-1847. doi:10.1016/s0022-5347(01)66796-x.

29. Raz S, Klutke CG, Golomb J. Four-corner bladder and urethral suspension for moderate cystocele. J Urol. 1989;142(3):712-715. doi:10.1016/s0022-5347(17)38863-8.

30. Gilja I, Puskar D, Mazuran B, Radej M. Comparative analysis of bladder neck suspension using Raz, Burch and transvaginal Burch procedures: a 3-year randomized prospective study. Eur Urol. 1998;33(3):298-302. doi:10.1159/000019563.

31. Kondo A, Kato K, Gotoh M, Narushima M, Saito M. The Stamey and Gittes procedures: long-term followup in relation to incontinence types and patient age. J Urol. 1998;160(3 Pt 1):756-758. doi:10.1016/S0022-5347(01)62778-2.

32. Elkabir JJ, Mee AD. Long-term evaluation of the Gittes procedure for urinary stress incontinence. J Urol. 1998;159(4):1203-1205. doi:10.1016/s0022-5347(01)63556-0.

33. Tebyani N, Patel H, Yamaguchi R, Aboseif SR. Percutaneous needle bladder neck suspension for the treatment of stress urinary incontinence in women: long-term results. J Urol. 2000;163(5):1510-1512. doi:10.1016/s0022-5347(05)67653-7.

34. Reid SV, Parys BT. Long-term 5-year followup of the results of the Vesica procedure. J Urol. 2005;173(4):1234-1236. doi:10.1097/01.ju.0000149030.31634.42.

35. Raz S, Stothers L, Young GP, et al. Vaginal wall sling for anatomical incontinence and intrinsic sphincter dysfunction: efficacy and outcome analysis. J Urol. 1996;156(1):166-170. doi:10.1016/s0022-5347(01)65976-7.

36. Kaplan SA, Te AE, Young GP, Andrade A, Cabelin MA, Ikeguchi EF. Prospective analysis of 373 consecutive women with stress urinary incontinence treated with a vaginal wall sling: the Columbia-Cornell University experience. J Urol. 2000;164(5):1623-1627. doi:10.1016/s0022-5347(05)67043-7.

37. Goldman HB, Rackley RR, Appell RA. The in situ anterior vaginal wall sling: predictors of success. J Urol. 2001;166(6):2259-2262. doi:10.1016/s0022-5347(05)65546-2.

38. Illiano E, Trama F, Marchesi A, Fabi C, Brancorsini S, Costantini E. Could the vaginal wall sling still have a role after FDA's warning? The functional outcomes at 20 years. Ther Adv Urol. 2022;14:17562872221084391. doi:10.1177/17562872221084391.

39. Ingelman-Sundberg A. Partial denervation of the bladder: a new operation for the treatment of urge incontinence and similar conditions in women. Acta Obstet Gynecol Scand. 1959;38:487-502. doi:10.3109/00016345909153948.

40. Hodgkinson CP, Drukker BH. Infravesical nerve resection for detrusor dyssynergia: the Ingelman-Sundberg operation. Acta Obstet Gynecol Scand. 1977;56(4):401-408. doi:10.3109/00016347709155001.

41. Ingelman-Sundberg A. Urge incontinence in women. Acta Obstet Gynecol Scand. 1975;54(2):153-156. doi:10.3109/00016347509156747.

42. Cespedes RD, Cross CA, McGuire EJ. Modified Ingelman-Sundberg bladder denervation procedure for intractable urge incontinence. J Urol. 1996;156(5):1744-1747. doi:10.1016/s0022-5347(01)65497-1.

43. Westney OL, Lee JT, McGuire EJ, Palmer JL, Cespedes RD, Amundsen CL. Long-term results of Ingelman-Sundberg denervation procedure for urge incontinence refractory to medical therapy. J Urol. 2002;168(3):1044-1047. doi:10.1016/S0022-5347(05)64571-5.

44. Bergman A, Elia G. Three surgical procedures for genuine stress incontinence: five-year follow-up of a prospective randomized study. Am J Obstet Gynecol. 1995;173(1):66-71. doi:10.1016/0002-9378(95)90171-x.

45. Leach GE, Dmochowski RR, Appell RA, et al. Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. J Urol. 1997;158(3 Pt 1):875-880. doi:10.1097/00005392-199709000-00054.

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