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Urinary incontinence - retropubic suspension

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

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.

Description

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

  • 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.

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:

  • Bleeding
  • Blood clots in the legs that may travel to the lungs
  • Breathing problems
  • 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
  • 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.

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.

Open References

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.

  • Urinary incontinence

    Animation

    •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.

  • Urinary incontinence

    Animation

    •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.

 

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.

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