Urinary incontinence - retropubic suspension
Open retropubic colposuspension; Marshall-Marchetti-Krantz (MMK) procedure; Laparoscopic retropubic colposuspension; Needle suspension; Burch colposuspensionRetropubic suspension is surgery to help control stress incontinence. This is urine leakage that happens when you laugh, cough, sneeze, lift things, or exercise. The surgery helps close your urethra and bladder neck. The urethra is the tube that carries urine from the bladder to the outside. The bladder neck is the part of the bladder that connects to the urethra.
Stress incontinence
Stress urinary incontinence occurs when your bladder leaks urine during physical activity or exertion. It may happen when you cough, sneeze, lift so...
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You receive either general anesthesia or spinal anesthesia before the surgery starts.
General anesthesia
General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel pain during surgery. After you receive the...
Read Article Now Book Mark Article- With general anesthesia, you are asleep and feel no pain.
- With spinal anesthesia, you are awake but numb from the waist down and feel no pain.
A catheter (tube) is placed in your bladder to drain urine from your bladder.
There are 2 ways to do retropubic suspension: open surgery or laparoscopic surgery. Either way, surgery may take up to 2 hours.
During open surgery:
- A surgical cut (incision) is made on the lower part of your belly.
- Through this cut the bladder is located. The doctor sews (sutures) the bladder neck, part of the wall of the vagina, and the urethra to the bones and ligaments in your pelvis.
- This lifts the bladder and urethra so they can close better.
During laparoscopic surgery, the doctor makes a smaller cut in your belly. A tube-like device that allows the doctor to see your organs (laparoscope) is put into your belly through this cut. The doctor sutures the bladder neck, part of the wall of the vagina, and the urethra to the bones and ligaments in the pelvis.
Why the Procedure Is Performed
This procedure is done to treat stress incontinence.
Stress incontinence
Stress urinary incontinence occurs when your bladder leaks urine during physical activity or exertion. It may happen when you cough, sneeze, lift so...
Read Article Now Book Mark ArticleBefore discussing surgery, your doctor will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried these and are still having problems with urine leakage, surgery may be your best option.
Risks
Risks for any surgery are:
- Bleeding
Bleeding
Bleeding is the loss of blood. Bleeding may be:Inside the body (internal)Outside the body (external)Bleeding may occur:Inside the body when blood le...
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Blood clots
Blood clots are clumps that occur when blood hardens from a liquid to a solid. A blood clot that forms inside one of your veins or arteries is calle...
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Breathing problems
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
Read Article Now Book Mark Article - Infection in the surgical cut, or opening of the cut
- Other infection
Risks for this surgery are:
- Abnormal passage (fistula) between the vagina and the skin
Fistula
A fistula is an abnormal connection between two body parts, such as an organ or blood vessel and another structure. Fistulas are usually the result ...
Read Article Now Book Mark Article - Damage to the urethra, bladder, or vagina
- Irritable bladder, causing the need to urinate more often
- More difficulty emptying your bladder, or the need to use a catheter
- Worsening of urine leakage
Before the Procedure
Tell your health care provider what medicines you are taking. These include medicines, supplements, or herbs you bought without a prescription.
During the days before the surgery:
- You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
- Ask which medicines you should still take on the day of your surgery.
- If you smoke, try to stop. Your provider can help.
On the day of your surgery:
- You will likely be asked not to drink or eat anything for 6 to 12 hours before the surgery.
- Take the medicines you have been told to take with a small sip of water.
- You will be told when to arrive at the hospital. Be sure to arrive on time.
After the Procedure
You will likely have a catheter in your urethra or in your abdomen above your pubic bone (suprapubic catheter). The catheter is used to drain urine from the bladder. You may go home with the catheter still in place. Or, you may need to perform intermittent catheterization. This is a procedure in which you use a catheter only when you need to urinate. You will be taught how to do this before you leave the hospital.
Catheter
A urinary catheter is a tube placed in the body to drain and collect urine from the bladder.
Read Article Now Book Mark ArticleYou may have gauze packing in the vagina after surgery to help stop bleeding. It is usually removed a few hours after surgery.
You may leave the hospital on the same day as surgery. Or, you may stay for 2 or 3 days after this surgery.
Follow instructions about how to care for yourself after you go home. Keep all follow-up appointments.
Outlook (Prognosis)
Urinary leakage decreases for most women who have this surgery. But you may still have some leakage. This may be because other problems are causing your urinary incontinence. Over time, some or all of the leakage may come back.
References
Hartigan SM, Chapple CR, Dmochowski RR. Retropubic suspension surgery for incontinence in women. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 123.
Kobashi KC, Albo ME, Dmochowski RR, et al. Surgical treatment of female stress urinary Incontinence: AUA/SUFU Guideline. J Urol. 2017;198(4):875-883. PMID: 28625508 pubmed.ncbi.nlm.nih.gov/28625508/.
Lentz GM, Miller JL. Lower urinary tract function and disorders: physiology of micturition, voiding dysfunction, urinary incontinence, urinary tract infections, and painful bladder syndrome. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 21.
Review Date: 1/1/2023
Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.