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Raz-Pereyra Trocar

The Raz-Pereyra trocar is a long ligature / fascia-carrying trocar designed for transvaginal-to-retropubic suture / fascial-strip passage in the surgical treatment of female stress urinary incontinence. The instrument has two distinct historical and contemporary use cases:

  • Historical (1959–1990s): transvaginal needle bladder-neck suspension — the Pereyra / Stamey / Raz family of operations, largely supplanted by midurethral slings and colposuspension on the basis of inferior long-term outcomes.[1][2][3]
  • Contemporary (in-scope): autologous rectus-fascia pubovaginal sling (PVS) — the gold-standard salvage operation for complex female SUI, where the trocar serves as the passage device that delivers the sling arms from the vaginal field to the retropubic / abdominal anchoring point.

Design​

  • Long stainless-steel trocar (~ 25–30 cm working length), reusable, autoclavable.
  • Beveled or forked distal end for capturing suture / fascial-strip tails on the vaginal side.
  • Slight curvature (variable by manufacturer) that approximates the retropubic-space arc from anterior rectus fascia down to the lateral aspect of the bladder neck and out through the anterior vaginal wall.
  • Multiple variants (single-pronged, double-pronged, curved, straight) — operator preference.

Contemporary Use — Autologous Rectus-Fascia Pubovaginal Sling​

The dominant in-scope use today. The trocar's role in a standard rectus-fascia PVS (the operation that has displaced mesh midurethral slings for many revisional / complex female SUI cases):

  1. Harvest a ~ 1 × 8 cm strip of rectus fascia through a small suprapubic Pfannenstiel incision; place an anchoring suture at each end.
  2. Small anterior vaginal-wall midline incision at the level of the mid-urethra; develop the retropubic space bilaterally with sharp + blunt dissection.
  3. Raz-Pereyra trocar passed under finger guidance from the suprapubic wound, down through the rectus fascia, through the retropubic space, and out the vaginal incision — one side at a time.
  4. Capture the fascial-strip suture tail at the vaginal side with the trocar tip; withdraw the trocar back through the retropubic tunnel, delivering the suture (and ultimately the fascial-sling arm) up to the abdominal wound. Repeat on the opposite side.
  5. Cystoscopy to confirm no bladder perforation before final tensioning.
  6. Tension at the mid-urethra without obstruction; tie the anchoring sutures together over the anterior rectus fascia.

The trocar is the transfascial-retropubic conduit — the operation cannot be performed without it (or a functional equivalent, e.g., a Stamey needle).

Why Autologous PVS Persists​

  • Gold-standard salvage after failed synthetic midurethral sling, failed Burch colposuspension, mesh complication, or in the patient who refuses synthetic mesh on principle.
  • Particularly favored for intrinsic sphincter deficiency (ISD) and complex revisional anatomy.
  • The 2017 SISTEr-trial long-term update and ongoing AUGS guideline conversations have re-centered autologous fascia in the female-SUI conversation as the highest-durability non-mesh option.

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
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 ~ 85% (range 40–100%) across ~ 2,000 procedures in the early-literature pool — limited by subjective endpoint definitions and short follow-up.[3]
  • Recurrent SUI: 83% Raz vs 78% Stamey reported cure rates.[5]
  • Postoperative voiding dysfunction in 20–50% across studies.[3]

Why the Needle Suspensions Fell Out of Favor​

  • Cochrane review (Glazener 2017) concluded that bladder-neck needle suspension is inferior to open retropubic colposuspension for SUI.[2]
  • JAMA scientific review (Holroyd-Leduc 2004) reached the same inferiority conclusion at the population level.[6]
  • Midurethral slings (TVT, TOT) displaced needle suspensions on the basis of shorter operative time, faster recovery, and superior medium-term outcomes.
  • Long-term durability of needle suspensions decayed beyond 5 years; sutures pulled through the periurethral tissues over time as the anchoring point was fascia / vaginal wall, not the urethra itself.

Needle bladder-neck suspension is now of primarily historical importance; the trocar persists on the modern tray only because it is the right instrument for the autologous-fascia PVS, which is the contemporary in-scope use.

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 technique, popularized the modern instrument, and went on to develop the autologous rectus-fascia PVS that defines the trocar's contemporary use. Raz is also the namesake of the URPS Raz lineage — see Surgical Genealogy.

Contemporary Trocar vs Adjacent Instruments​

InstrumentBest fitStatus
Raz-Pereyra trocarAutologous rectus-fascia PVS (contemporary); needle bladder-neck suspension (historical)In active use on the urogyn / FPMRS tray
Stamey needleDouble-pronged ligature-carrying needle for Stamey-modification needle suspension; some surgeons use for autologous PVSPrimarily historical; mid-urethral slings have supplanted
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: 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.

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.

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