Urinary incontinence - retropubic suspension


Definition

Retropubic 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.

Alternative Names

Open retropubic colposuspension; Marshall-Marchetti-Krantz (MMK) procedure; Laparoscopic retropubic colposuspension; Needle suspension; Burch colposuspension

Description

You receive either general anesthesia or spinal anesthesia before the surgery starts.

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:

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.

Before 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:

Risks for this surgery are:

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:

On the day of your surgery:

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.

You 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

Chapple CR. Retropubic suspension surgery for incontinence in women. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 82.

Dmochowski RR, Blaivas JM, Gormley EA, et al. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183(5):1906-1914. PMID: 20303102 www.ncbi.nlm.nih.gov/pubmed/20303102.

Kirby AC, Lentz GM. Lower urinary tract function and disorders: physiology of micturition, voiding dysfunction, urinary incontinence, urinary tract infections, and painful bladder syndrome. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 21.

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