An updated Cochrane review [Abstract] 1 included 10 studies with a total of 375 women having six different types of needle suspension procedures and 489 who received comparison interventions. Needle suspensions were more likely to fail than open abdominal retropubic suspension (higher subjective failure rate after the first year (91/313, 29% failed versus 47/297, 16% failed after open abdominal retropubic suspension: the relative risk (RR) was 2.00 (95% confidence interval (CI) 1.47 to 2.72) although the difference in peri-operative complications was not significant (17/75, 23% versus 12/77, 16%; RR 1.44, 95% CI 0.73 to 2.83): there were no significant differences for other outcome measures. This effect was seen in both women with primary incontinence and women with recurrent incontinence after failed primary operations. Needle suspensions may be as effective as anterior vaginal repair (50/156, (32 % failed after needles versus 64/181, 35 % after anterior repair; RR 0.86, 95% CI 0.64 to 1.1) but there was little information about morbidity. Data for comparison with suburethral slings were inconclusive because they came from a small and atypical population.
Comment: The quality of evidence is downgraded by sparse data and heterogeneity in interventions. No trials compared needle suspensions with conservative management, peri-urethral injections or sham or laparoscopic surgery.
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