Comparison of anchors used in anti-incontinence surgery

Objectives. To compare the resistance to caudally directed force at different fixation points used in female anti-incontinence surgery. Methods. Sutures were placed in Cooper's ligament, rectus fascia, and in bone anchors on the pubic symphysis in 6 fresh, unembalmed cadavers and transposed vaginally with a ligature carrier. Force was applied in a caudal direction to each suture. Displacement of the suture with increasing force and the force required to overcome the cranial fixation point were measured with a highly precise force gauge. Two measurements were made for each anchor point and the measurements were averaged. Results. With caudally directed force, sutures fixed to Cooper's ligament were displaced to an equal extent as sutures attached to a bone anchor. Sutures anchored to the rectus fascia were displaced the most with increasing force. The maximal force supported by Cooper's ligament fixation and bone anchors was similar. The event limiting each test was suture breakage, except when one suture anchored in the rectus fascia tore out. Conclusions. In a cadaver model, bone anchors placed in the pubic symphysis offer no structural advantage over Cooper's ligament fixation.