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Stamey Needle

Long eyelet-bearing suture carrier associated with the Stamey endoscopic bladder-neck suspension for stress urinary incontinence (SUI), a modification of Pereyra needle suspension. Published descriptions include cystoscopic inspection after passage and Dacron tubular bolsters to distribute suture tension. These historical procedure features are not a guarantee against injury or later erosion.[1][2][16]

Stamey's named needle-suspension operation is now primarily historical, but the instrument remains in use: published autologous pubovaginal-sling techniques use its eyelet to deliver graft suture arms through the retropubic space.[15]

Design​

  • Long rigid needle with a suture eyelet, not a universal double-pronged or forked tip. Published historical technique threads nylon through the eyelet; modern PVS teaching also describes using that eyelet for graft suture arms.[15][16]
  • A current instrument catalog lists straight, 15° and 30° variants (CSU403-0, CSU403-15 and CSU403-30). Length, material, tip, reuse and sterilization specifications were not established from that listing; check the exact manufacturer's instructions.[17]
  • Retropubic passage is finger-guided; cystoscopy follows the passes to look for urinary-tract injury. The needle itself does not provide endoscopic visualization.[15][16]

The Stamey Procedure — Step-by-Step​

The Stamey endoscopic bladder-neck suspension:[1][2][3][4]

  1. Position: dorsal lithotomy; Foley catheter in place.
  2. Vaginal incision: small transverse vaginal incision at the level of the bladder neck; vaginal mucosa dissected laterally to expose paraurethral endopelvic fascia bilaterally.
  3. Suprapubic access: small incisions above the symphysis; location and length vary by technique.
  4. Needle passage. Stamey needle passed from the suprapubic incision through rectus fascia, into the retropubic space (space of Retzius), down to the vaginal incision on each side of the bladder neck, blindly, guided by the surgeon's vaginal finger.
  5. Cystoscopic inspection after needle passage to look for bladder or urethral injury; negative inspection does not eliminate every complication.[1][15]
  6. Suture placement with Dacron bolsters. Historical techniques used nylon threaded through the eyelet and a Dacron tube at the vaginal-tissue level to spread load. Bolsters did not eliminate later suture or foreign-body complications.[1][2][16]
  7. Suture fixation: sutures tied over the rectus fascia at the suprapubic incisions, suspending the bladder neck; tension adjusted under cystoscopic visualization.
  8. Closure: vaginal and suprapubic incisions closed. Suprapubic or Foley catheter for postoperative drainage.

The Two Stamey Innovations​

The Stamey procedure introduced two modifications to the original Pereyra (1959) transvaginal needle suspension:[1][2][5]

  1. Cystoscopic inspection as part of the operation to identify urinary-tract injury after passage; a quantified reduction versus original Pereyra was not established here.
  2. Dacron bolsters. Tubular polyester sleeves distributing tension at the paraurethral-tissue level; a 40-year-late erosion case illustrates that foreign-body complications remain possible, without establishing their incidence.[16]

Stamey vs Pereyra vs Raz vs Burch vs TVT​

ProcedureYearApproachCystoscopyBolstersNiche
Pereyra (original)1959Vaginal → suprapubicNo (original)NoneFoundational needle suspension
Stamey1973Suprapubic ↔ vaginalYesDacronEndoscopic-verified needle suspension
Raz1981VaginalYesNone; broader vaginal-wall biteVaginal-wall incorporation
Burch colposuspension1961Open abdominal retropubicNoPermanent suturesOpen abdominal — superior efficacy[3]
TVT (midurethral sling)1996Vaginal retropubic mesh-tape passageYesPolypropylene mesh tapeEstablished modern SUI option; distinct from needle suspension[19]

Outcomes​

Short-term​

  • Early results varied by case mix and endpoint. In Nigam's 72-procedure combined Stamey and Gittes series, 93% were dry at three months; this is not a Stamey-only estimate.[6]

Long-term — progressive decline​

The Stamey procedure's defining outcome pattern is progressive long-term failure:

  • Kaplan-Meier cumulative continence 71.5% at 14 yr (Kondo 1998, n = 342, mean follow-up 8.1 yr).[8]
  • 50% complete continence at mean 5.5 yr (Conrad 1997, n = 130; 38.5% recurrence at 6–90 mo); ~ two-thirds believed they were cured or substantially improved at > 5 yr.[9]
  • 69.8% reported no pads in 63 evaluable women at mean 7.5 yr in Gofrit's series; the pure-SUI subgroup was 93%, versus 33% among those with severe urge symptoms. These subgroup estimates are small and not interchangeable with the overall result.[7]
  • 38% dry or improved at 5 yr and 28% at 9 yr after Stamey in Nigam's small series; 26% of the combined Stamey and Gittes cohort underwent a second procedure. Repeat needle operations failed in that observed cohort, not necessarily in every patient.[6]
  • 44% dry at median 15 yr (Clemens 1998, direct versus MMK 33% at median 16.8 yr), parallel progressive declines.[10]

Stamey vs Burch — the comparative landmark​

The 2017 Cochrane review found needle suspension less effective than open retropubic suspension at one year or more: 91/313 failures (29%) versus 47/297 (16%), equivalent to approximately 71% versus 84% without failure. The comparison drew on small, low-quality trials and was not a direct Stamey-versus-Burch estimate. Sling comparisons were inconclusive.[3] The JAMA Holroyd-Leduc 2004 scientific review also discussed the inferior durability of needle suspension.[11]

Complications​

  • Voiding dysfunction: 12–50%; significantly higher than Burch in comparative work.[2][12]
  • De novo urge incontinence or detrusor instability: approximately 12%, related to postoperative obstruction.[8][12]
  • Urinary urgency: 70% of Stamey patients at median 15 yr (versus 23% MMK).[10]
  • Suture-related complications: Dacron-bolster foreign-body reaction; suture pull-through despite bolsters.[5]
  • Bladder perforation: a risk of retropubic passage; cystoscopy can identify injury but does not prevent the needle pass itself.[4][15]
  • Persistent local side effects: 9% at long-term follow-up.[10]
  • Wound infection, hematoma, osteitis pubis (rare).

Patient Selection — Where Stamey Worked Best​

The following historical series describe prognostic observations, not current indications to offer needle suspension. UK NICE guidance explicitly recommends not offering this operation for female SUI.[18]

  • Pure stress incontinence (type I or II) with urethral or bladder-neck hypermobility: long-term success in pure-SUI subgroups up to 76% at 11 yr (type I), 74% at 13 yr (type II).[8][7]
  • Recurrent SUI with persistent bladder-neck hypermobility after failed prior surgery. Ramon 1991 reported 78% cure in the Stamey arm (18 of 36 patients; the rest had Pereyra-Raz cystourethropexy) of a small retrospective series.[13]
  • Age-independent: long-term continence not significantly different by patient age.[8]

Where Stamey failed​

  • Type III or intrinsic sphincter deficiency. Kondo reported 38.3% cumulative continence at 10 years in this subgroup; modern procedure selection requires current guidance and individual assessment rather than extrapolation from this one historical cohort.[8]
  • Mixed UI with severe urge: long-term success drops sharply.[7]
  • Repeat needle suspension. Repeat operations failed in Nigam's observed cohort; this is a warning signal and gives no universal failure probability.[6]

Current Status​

The Stamey suspension is primarily historical. Early series reported success near 90% (Vondermark 1979, 20 patients, matched to MMK), but with short follow-up and retrospective definitions. Later questionnaire and long-term series report lower continence rates, and NICE recommends against offering needle suspension.[1][6][9][18] The Stamey needle remains a distinct suture carrier for certain autologous PVS techniques.[15]

Straight and angled Stamey needles remain cataloged; contemporary tray prevalence was not established. Do not equate the historical suspension's declining use with obsolescence of the instrument. Follow the actual device instructions and recognize that needle suspension, autologous PVS and synthetic MUS use different techniques and risk profiles.[15][17]

For RU/urogyn surgeons today, the contemporary alternatives are:

  • Tension-free vaginal tape (TVT) and other midurethral slings are established surgical options for primary SUI; EAU strongly recommends offering a midurethral sling after discussing risks and benefits.[19]
  • Autologous fascia-lata pubovaginal sling with Crawford-stripper harvest: for ISD, recurrent SUI, mesh-avoidant patients.
  • Burch colposuspension: open retropubic alternative with direct comparison against needle suspension; laparoscopic colposuspension is a related but separately reviewed approach and was not the comparator in those older trials.[3][14]
  • Separate prolapse assessment and repair when indicated; sacrocolpopexy itself is not a stand-alone SUI treatment.

Historical Context — Thomas A. Stamey​

Thomas Allen Stamey (1928–2017) was Chairman of the Department of Urology at Stanford University School of Medicine for over two decades. His contributions across urology were extraordinarily broad:

  • Prostate-specific antigen (PSA). Published one of the seminal papers establishing PSA as a marker for prostate-cancer volume and staging; instrumental in widespread PSA screening adoption. Later became one of its most prominent critics on the basis of overdiagnosis and overtreatment.
  • Urinary tract infections. Foundational work on recurrent UTI in women; author of Pathogenesis and Treatment of Urinary Tract Infections.
  • Stamey endoscopic bladder-neck suspension (1973). The procedure described on this page.
  • Meares–Stamey four-glass test. Segmented specimen approach historically used to help localize prostatic infection.
  • Suprapubic catheter. The Stamey suprapubic-catheter design used widely for bedside and operative bladder drainage (still on every RU and urogyn tray; see Suprapubic Catheter).

See also: Raz-Pereyra Trocar, Crawford Fascial Stripper, Suprapubic Catheter.

References​

1. Vondermark JS, Brannen GE, Wettlaufer JN, Modarelli RO. "Suprapubic endoscopic vesical neck suspension." J Urol. 1979;122(2):165–7. doi:10.1016/s0022-5347(17)56307-7

2. 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.

3. 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

4. Fitzpatrick CC, Elkins TE, DeLancey JO. "The surgical anatomy of needle bladder neck suspension." Obstet Gynecol. 1996;87(1):44–9. doi:10.1016/0029-7844(95)00355-x

5. Varner RE. "Retropubic long-needle suspension procedures for stress urinary incontinence." Am J Obstet Gynecol. 1990;163(2):551–7. doi:10.1016/0002-9378(90)91196-j

6. Nigam AK, Otite U, Badenoch DF. "Endoscopic bladder neck suspension revisited: long-term results of Stamey and Gittes procedures." Eur Urol. 2000;38(6):677–80. doi:10.1159/000020361

7. Gofrit ON, Landau EH, Shapiro A, Pode D. "The Stamey procedure for stress incontinence: long-term results." Eur Urol. 1998;34(4):339–43. doi:10.1159/000019751

8. 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):756–8. doi:10.1016/S0022-5347(01)62778-2

9. Conrad S, Pieper A, De la Maza SF, Busch R, Huland H. "Long-term results of the Stamey bladder neck suspension procedure: a patient questionnaire based outcome analysis." J Urol. 1997;157(5):1672–7.

10. Clemens JQ, Stern JA, Bushman WA, Schaeffer AJ. "Long-term results of the Stamey bladder neck suspension: direct comparison with the Marshall-Marchetti-Krantz procedure." J Urol. 1998;160(2):372–6.

11. 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

12. Wang AC. "Burch colposuspension vs. Stamey bladder neck suspension. A comparison of complications with special emphasis on detrusor instability and voiding dysfunction." J Reprod Med. 1996;41(7):529–33.

13. 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

14. Freites J, Stewart F, Omar MI, Mashayekhi A, Agur WI. "Laparoscopic colposuspension for urinary incontinence in women." Cochrane Database Syst Rev. 2019;12:CD002239. doi:10.1002/14651858.CD002239.pub4

15. 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 describing Stamey eyelet or clamp passage and cystoscopy.

16. Salfity L, Dekel E, Sahai A, Faure Walker N. Late urological manifestation of stress incontinence surgery. BMJ Case Rep. 2021;14(5):e241660. doi:10.1136/bcr-2021-241660. Single case with a detailed description of the eyelet and Dacron bolster; not an incidence study.

17. CSS Surgical. Stamey needles catalog, straight, 15° and 30° variants (accessed September 2026).

18. 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).

19. European Association of Urology. EAU Guidelines on Non-neurogenic Female LUTS: Disease Management, surgical-treatment recommendations (accessed September 2026).