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 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 surgeon 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 surgeon 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 surgeon 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 surgeon 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 and surgeon what medicines you are taking. These include medicines, supplements, or herbs you bought without a prescription.
Tell your surgeon or nurse if:
- You are or could be pregnant
- You are taking any medicines, including medicines, supplements, or herbs you bought without a prescription
- You have been drinking a lot of alcohol, more than 1 or 2 drinks a day
Planning for your surgery:
- If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats you for these conditions.
- If you smoke, it's important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help quitting smoking.
- If needed, prepare your home to make it easier to recover after surgery.
- Ask your surgeon if you need to arrange to have someone drive you home after your surgery.
During the week before your surgery:
- You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
- Ask your surgeon which medicines you should still take on the day of surgery.
- Let your surgeon know about any illness you may have before your surgery. This includes COVID-19, a cold, flu, fever, herpes breakout, or other illness. If you do get sick, your surgery may need to be postponed.
On the day of surgery:
- Follow instructions about when to stop eating and drinking.
- Take the medicines your surgeon told you to take with a small sip of water.
- Follow instructions on 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
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, Vasavada S, Bloschichak A, et al. Updates to surgical treatment of female stress urinary incontinence (SUI): AUA/SUFU Guideline (2023). J Urol. 2023;209(6):1091-1098. PMID: 37096580 pubmed.ncbi.nlm.nih.gov/37096580/.
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.
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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