Retropubic suspension for urinary incontinence in women

Surgery Overview

Retropubic suspension surgery is used to treat urinary incontinence by lifting the sagging bladder neck and urethra that have dropped abnormally low in the pelvic area. Retropubic suspension is abdominal surgery, where access to the bladder and urethra is gained by making an incision in the abdominal wall.

The most common procedures used for retropubic suspension are:

• Marshall-Marchetti-Krantz (MMK) procedure, in which the urethra and/or the bladder are attached to a sturdy structure in the pelvis such as the back of the pubic bone.
• Burch colposuspension procedure, in which the vaginal wall is attached to a ligament (Cooper's ligament) next to the pubic bone.

What To Expect After Surgery

Since these procedures involve abdominal surgery, hospitalization is required. To allow healing of the urinary tract, a catheter is placed into the bladder through the urethra (or abdominal wall) to allow urine to drain. The catheter is usually removed in about 10 days.

You will likely go home 2 to 3 days after the surgery if there have been no complications. After you are at home, expect a 2- to 4-week recovery period, during which you should refrain from doing too much work or strenuous activities of any kind.

The amount of pain you experience after surgery depends on the exact nature of your procedure, your physical condition at the time of surgery, and your own response to pain. You will probably feel some pain at the incision site and may feel some cramping in your abdomen. Your doctor will prescribe medicine to relieve your discomfort during the first few days after surgery. Be sure to call your doctor if you cannot get relief from pain.

Many women have some constipation after this surgery. Make sure you drink enough fluids—between 8 and 10 glasses of water or noncaffeinated beverages each day. Include fruits, vegetables, and fiber in your diet. Add some processed or synthetic fiber (such as Citrucel, Metamucil, or Perdiem) to your diet, or try a stool softener, such as Colace or Peri-Colace, if your stools are very hard. Be sure to tell your doctor if constipation persists even after these methods have been tried.

Why It Is Done

Retropubic suspension is used to correct stress incontinence that is caused by sagging of the urethra and/or bladder neck.

How Well It Works

Retropubic suspension is considered to be effective in relieving stress incontinence. Most women have fewer symptoms of stress incontinence after this surgery.

• Marshall-Marchetti-Krantz (MMK) procedure: Women experience short- and medium-term relief from stress incontinence symptoms after the MMK procedure. But the symptoms of incontinence may recur as years go by. One study reported that 43% of women experienced incontinence symptoms 5 years after surgery, and 72% experienced incontinence symptoms 10 years after surgery.¹
• Burch colposuspension procedure: Women usually experience long-term relief from incontinence symptoms. One study found that about 69% of women who had the colposuspension procedure for stress incontinence experienced relief from their symptoms up to 13 years after surgery.¹

Both the MMK procedure and colposuspension show better results if done for women who have not previously had surgery for stress incontinence.

Risks

Complications of retropubic surgery may include urination difficulties.¹

All abdominal surgeries have a risk of complications, including:

• Internal bleeding.
• Infection at the incision site.
• Injury to an organ (such as the bladder, urethra, or ureters).
• Abscess, a pocket of pus that forms at the site of infected tissue.
• Pulmonary embolism, the sudden blockage of arterial blood flow within the lung.
• Urinary tract infection, when bacteria—or, more rarely, a virus or fungus—begin to grow in the urinary tract.

All surgeries that use general anesthesia have a small risk of death or complications. All surgeries carry some risk of infection.

What To Think About

Retropubic suspension procedures require that a thin, flexible tube (catheter) be kept in place for a day or more, until you can get up independently to use the toilet. This may be uncomfortable and increases the risk of acquiring a urinary tract infection.

Before having surgery for urinary incontinence, ask your doctor about the following:

• How much success has the doctor had in treating incontinence with surgery? The success of surgical procedures for urinary incontinence depends on the experience and skill of the surgeon.
• Is there anything you can do to increase the likelihood of a successful surgery? Losing weight, quitting smoking, or doing pelvic floor (Kegel) exercises prior to surgery may increase the likelihood of regaining continence after surgery.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Author:	Sandy Jocoy, RN	Last Updated: September 17, 2008
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Avery L. Seifert, MD - Urology
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