(Retropubic Bladder Suspension; Laparoscopic Retropubic Bladder Suspension; Open Retropubic Bladder Suspension)
Definition
Definition
Urethral suspension is a surgery to reduce or correct stress incontinence in women. This process uses stitches to support the bladder and urethra, the tube that carries urine from the bladder to the outside of the body.
Female Bladder and UrethraCopyright © Nucleus Medical Media, Inc.
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Reasons for Procedure
Reasons for Procedure
Stress incontinence is uncontrolled leaking of urine. Muscles in the pelvis support the bladder and urethra. When these muscles are weakened these structures can fall out of position. This makes it difficult to prevent urine leakage from the bladder when there is pressure on bladder, like coughing. The vaginal wall is also close to the bladder and urethra. If the vagina is in a weak position it can also make it difficult for the bladder and urethra to work properly.
A bladder suspension lifts the bladder by securing it to nearby pelvic structures like to the pelvic bone. Lifting the bladder makes it easier for the bladder to close when it should to stop urine leakage into the urethra.
Possible Complications
Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have a urethral suspension, your doctor will review a list of possible complications, which may include:
- Bleeding
- Infection
- Reactions to anesthesia
- Inability to urinate
- Continued incontinence or recurrence of the problem
- Damage to other nearby organs or blood vessels
- Pain, such as during sexual intercourse
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
- Smoking
- Drinking
- Chronic disease such as diabetes or obesity
What to Expect
What to Expect
Prior to Procedure
A series of tests will be done to determine the cause of incontinence. Surgery is only considered after other nonsurgical treatments have been tried. The results from the tests may also be used to prepare for surgery.
Leading up to surgery:
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
- Arrange for a ride home from the hospital.
- Do not eat or drink anything after midnight the night before.
Anesthesia
The choice of anesthesia will depend on the doctor, your specific procedure, your medical history, and your preferences. You may receive one of the following:
- Spinal anesthesia—to numb your lower body but you will be awake.
- General anesthesia—you will be asleep.
Description of Procedure
The exact steps to the surgery will depend on your overall health and amount of support that is needed. Options for the doctor to gain access to the area include:
- Open procedure—An incision is made in the abdomen. The doctor will be able to view the area.
- Laparoscopic procedure—2-3 small incisions will be made in the naval and above the pubic hairline. Small instruments can be inserted through these incisions to complete the procedure.
- Transvaginal procedure—A small incision is made in the front vaginal wall.
Once the area is available sutures will be made to secure the organs to the pelvis. Sutures will be made in the neck of the bladder, the urethra and the vaginal wall. These sutures will then be anchored to the strong ligaments on the front of the pelvis. The sutures will be set to lift and support the structures. Once the sutures are in place the doctor will test to make sure the structures are in the desired position. After the placement is confirmed the sutures will be closed with sutures or surgical glue.
Immediately After Procedure
After surgery, you will be monitored in a recovery room. A catheter will be in place to allow the urinary tract to rest and drain the urine.
How Long Will It Take?
1-1.5 hours
How Much Will It Hurt?
Anesthesia will block pain during the surgery. After surgery, you may experience some pain or soreness. You will be given pain medication to relieve discomfort.
Average Hospital Stay
You may be sent home the same day if there are no complications.
Postoperative Care
At the Hospital
The catheter will be removed once urine is passing as expected. Walking will be encouraged early to promote healing and decrease the risk of certain complications.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping any incisions covered
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch incisions
At Home
There will be some activity limits after the procedure. Lifting and strenuous exercise will be limited for 6 weeks.
Call Your Doctor
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Pain that you cannot control with the medications you have been given
- Cough, shortness of breath, or chest pain
- Severe nausea or vomiting
- Trouble urinating
- Pain, burning, urgency, or frequency while urinating
In case of an emergency, call for emergency medical services right away.
RESOURCES:
Urology Care Foundation http://www.urologyhealth.org
CANADIAN RESOURCES:
Canadian Urological Association http://www.cua.org
References:
http://intermountainhealthcare.org/ext/Dcmnt?ncid=520693119
Accessed May 27, 2015.
FAQ mid-urethral slings for stress urinary incontinence. Society of Urodynamics Female Pelvic Medicine and Urogenital Reconstruction website. Available at:
http://www.sufuorg.com/docs/news/Patient-FAQs-MUS-for-posting.aspx
Accessed May 27, 2015.
Surgical management of urinary incontinence. Urology Care Foundation website. Available at:
http://www.urologyhealth.org/urology/index.cfm?article=33
Updated January 2011. Accessed October 27, 2014.
Surgical mesh. US Food and Drug Administration website. Available at:
http://www.augs.org/p/cm/ld/fid=163
Updated January 4, 2012. Accessed October 27, 2014.
Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at:
http://www.nafc.org/bladder-bowel-health/types-of-incontinence/stress-incontinence/surgical-treatment-for-female-stress-urinary-incontinence/
Accessed October 27, 2014.
Townsend MK, Danforth KN, et al. Physical activity and incident urinary incontinence in middle-aged women. J Urol. 2008;179:1012-1016; discussion 1016-1017.
6/3/2011 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last Updated: 5/18/2015