Transvaginal bladder neck suspension to the cooper ligament using an in-line needle driver

Objective: To describe a transvaginal bladder neck suspension using the in-line needle driver. Methods: The transvaginally exposed endopelvic fascia is sutured at the bladder neck with three helical bites bilaterally. A 2-cm skin incision is made bilaterally, parallel to the inguinal ligament and midway between the pubic symphysis and the anterior superior iliac spine, and carried down to the space of Retzius. The sutures are passed suprapubically. One end of each suture is anchored to the Cooper ligament using the in-line needle driver, which is guided by palpation. The sutures are tied bilaterally to suspend the bladder neck. Results: All 15 patients were subjectively cured after a mean follow-up of 12 months. All patients had improvement to less than 30° cotton-swab test on follow-up examinations. Conclusion: The use of the in-line needle driver for transvaginal bladder neck suspension provides access to the relevant anatomic structures and simulates the modified Burch colposuspension in the anatomic effect it accomplishes.