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.

      • 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 two 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 of any surgery are:

      Risks of 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), 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.

  • References
    • Appell RA, Dmochowski RR, Blaivas JM, Gormley EA, et al. Female Stress Urinary Incontinence Update Panel of the American Urological Association Education and Research, Inc, Whetter LE. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183:1906-14. PMID: 20303102

      Chapple CR. Retropubic suspension surgery for incontinence in women. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 71.

      Wai CY. Surgical treatment for stress and urge urinary incontinence. Obstet Gynecol Clin North Am. 2009;36:509-19. PMID: 19932413