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Stamey Needle

Long, straight or slightly curved, double-pronged ligature-carrying needle used to perform the Stamey endoscopic bladder-neck suspension for stress urinary incontinence (SUI) — the 1973 modification by Thomas A. Stamey of the original 1959 Pereyra transvaginal needle suspension. The Stamey modification introduced two innovations that defined the procedure: endoscopic (cystoscopic) verification of needle passage and Dacron tubular bolsters to prevent suture pull-through.[1][2]

Stamey's place in urogyn surgery sits in the Pereyra → Stamey → Raz → TVT lineage — needle-suspension procedures dominated SUI surgery from the 1970s through the mid-1990s before the tension-free vaginal tape (TVT) displaced them, and the Stamey needle today is primarily of historical and educational significance.[14][11]

Design​

  • Long straight or slightly curved stainless-steel needle, ~ 15–20 cm, rigid enough to maintain its trajectory through the retropubic space during blind passage.
  • Double-pronged (forked) distal tip that captures and carries suture material through the retropubic space — the two prongs form a small gap that holds the suture securely during passage.
  • Suture-carrying mechanism: threads nylon or polypropylene sutures from the vaginal incision through the retropubic space to the anterior abdominal wall (rectus fascia).
  • Handle / grip at the proximal end for controlled needle passage.
  • Cystoscopy-compatible: the needle is passed while concurrent cystoscopy verifies that the bladder has not been perforated — the Stamey innovation over the original blind Pereyra technique.[1][3]

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 incisions: two small (1–2 cm) transverse skin incisions just above the pubic symphysis, ~ 2–3 cm apart on each side of midline.
  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 verification — performed during / immediately after passage to confirm no bladder perforation. The key Stamey innovation.[1][3]
  6. Suture placement with Dacron bolsters: nylon suture threaded through the needle and looped through the paraurethral endopelvic fascia at the bladder neck. Dacron tubular bolsters placed over the sutures at the vaginal-tissue level to prevent suture cut-through — the second Stamey innovation.[1][2]
  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 critical modifications to the original Pereyra (1959) transvaginal needle suspension:[1][2][5]

  1. Endoscopic (cystoscopic) guidance — concurrent cystoscopy during needle passage; significantly reduced unrecognized bladder injury vs the original blind Pereyra technique.
  2. Dacron bolsters — small tubular polyester sleeves over the suspensory sutures at the paraurethral-tissue level; distributed tension over a larger area, reducing the suture-pull-through that drove recurrence in the original Pereyra technique.

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 trans-vaginal-tapeYesPolypropylene mesh tapeModern standard — supplanted needle suspensions[11][14]

Outcomes​

Short-term​

  • Initial cure rates 85–93% at 3 months.[2][6][7]

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% long-term success at mean 7.5 yr in pure-SUI patients (93% in pure SUI); significantly worse with mixed symptoms (33% with severe urge).[7]
  • 38% dry / improved at 5 yr, 28% at 9 yr; 26% required second procedure; all repeat needle operations failed.[6]
  • 44% dry at median 15 yr (Clemens 1998, direct vs MMK 33% at median 16.8 yr) — parallel progressive declines.[10]

Stamey vs Burch — the comparative landmark​

The 2017 Cochrane review (Glazener) concluded needle suspension is probably less effective than open retropubic suspension (Burch colposuspension) — cure rates 71% needle suspension vs 84% open retropubic.[3] The JAMA Holroyd-Leduc 2004 scientific review reached the same conclusion.[11]

Complications​

  • Voiding dysfunction — 12–50%; significantly higher than Burch in comparative work.[2][12]
  • De novo urge incontinence / detrusor instability — ~ 12%, related to postoperative obstruction.[8][12]
  • Urinary urgency — 70% of Stamey patients at median 15 yr (vs 23% MMK).[10]
  • Suture-related complications — Dacron-bolster foreign-body reaction; suture pull-through despite bolsters.[5]
  • Bladder perforation — reduced by cystoscopic verification but not eliminated.[3][4]
  • Persistent local side effects — 9% at long-term follow-up.[10]
  • Wound infection, hematoma, osteitis pubis (rare).

Patient Selection — Where Stamey Worked Best​

For the small minority of contemporary cases where Stamey-style needle suspension is still entertained (resource-limited settings, mesh-avoidant patients ineligible for autologous PVS, specific historical indications):

  • Pure stress incontinence (type I or II) with urethral / 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% success.[13]
  • Age-independent — long-term continence not significantly different by patient age.[8]

Where Stamey failed​

  • Type III ISD (intrinsic sphincter deficiency) — 10-yr continence only 38.3%; needle suspension should not be used. Autologous fascia-lata PVS (Crawford-stripper harvest) or midurethral sling are preferred.[8]
  • Mixed UI with severe urge — long-term success drops sharply.[7]
  • Repeat needle suspension — all repeat needle operations in Nigam 2000 failed; salvage requires a different procedure.[6]

Current Status​

The Stamey needle and the procedure it enabled are primarily of historical significance. Needle suspensions dominated 1970s–mid-1990s SUI surgery, with overall reported success ~ 85% (range 40–100%) across ~ 2,000 procedures in the published literature — likely inflated by short follow-up and subjective cure criteria.[2] The tension-free vaginal tape (TVT, Ulmsten 1996) fundamentally changed the landscape; midurethral slings are now the most commonly performed anti-incontinence operation worldwide, with comparable or superior efficacy and more durable long-term results.[14][11]

The Stamey needle itself remains available from instrument manufacturers but rarely on contemporary SUI trays. Its legacy lies in the conceptual innovations: endoscopic verification of needle placement and bolster-reinforced suture fixation, both of which influenced subsequent design (the TVT trocar / needle delivery systems, the Raz-Pereyra trocar family).

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

  • Tension-free vaginal tape (TVT) and other midurethral slings — first-line for primary SUI.
  • Autologous fascia-lata pubovaginal sling with Crawford-stripper harvest — for ISD, recurrent SUI, mesh-avoidant patients.
  • Burch colposuspension — open retropubic alternative with the strongest comparative evidence base vs needle suspension.
  • Sacrocolpopexy and pelvic-floor reconstruction — for SUI in the context of prolapse repair.

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.
  • Stamey test — segmented urine-culture technique for localizing bacterial infections within the urinary tract.
  • Suprapubic catheter — the Stamey suprapubic-catheter design used widely for bedside and operative bladder drainage (still on every RU/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