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Urinary incontinence - retropubic suspension

Definition

Retropubic suspension is surgery to help control urine leakage that can happen when you laugh, cough, sneeze, lift things, or exercise ( stress incontinence). The surgery helps close your urethra (the tube that carries urine from the bladder to the outside) and the bladder neck (the part of the bladder that connects to the urethra).

See also:

Alternative Names

Open retropubic colposuspension; Laparoscopic retropubic colposuspension; Needle suspension; Burch colposuspension

Description

You will have either general anesthesia or spinal anesthesia before the retropubic suspension procedure. With general anesthesia, you will be asleep and feel no pain. With spinal anesthesia, you will be awake but numb from the waist down. You will not feel pain.

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 is made on the lower part of your belly.
  • Through this cut the bladder is located. The doctor will sew 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 will make a smaller cut in your belly. A a tube-shaped medical device that allows the doctor to see your organs (laparoscope) is put into your belly through this cut. The doctor will sew 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.

Most of the time, your doctor will have you try bladder retraining or Kegel exercises before talking about surgery with you.

Risks

Risks for any surgery are:

Risks for this surgery are:

  • Damage to the urethra, bladder, or vagina
  • Fistula (connection) between the vagina and the skin
  • Irritable bladder, where you may feel the need to urinate more often
  • It may be harder to empty your bladder, or you may not be able to empty your bladder and need a catheter (tube that drains urine from your bladder)
  • Urine leakage may get worse

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, 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 drugs that make it hard for your blood to clot.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you smoke, try to stop. Your doctor can help.

On the day of your surgery:

  • You will usually be asked not to drink or eat anything for 6 to 12 hours before the surgery.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

You may be asked to shave your pubic area before the operation.

After the Procedure

Most people will have a catheter in their urethra or above their pubic bone after this surgery so that urine can drain from the bladder. Some people may need to go home with a catheter still in place, or they may need to perform intermittent catheterization. This is a procedure where you use a catheter only when you need to urinate. You will be taught how to do this before you leave the hospital.

Many patients leave the hospital on the same day as surgery. Sometimes, patients stay for 2 or 3 days after this surgery.

You may have gauze packing in the vagina after surgery to help stop bleeding. It is usually removed a few hours after surgery.

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, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders; 2007:chap 65.

Takacs EB, Kobashi KC. Minimally invasive treatment of stress urinary incontinence and vaginal prolapse. Urol Clin North Am. 2007;35(3):467-476.

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;183:1906-1914.


Review Date: 1/13/2011
Reviewed By: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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