Urethral suspension

Alternative names
Surgeries for female stress incontinence help control involuntary urination by elevating the urethra and bladder.; Marshall-Marchetti operation; Vesicourethral suspension; MMK; Pubo-vaginal sling; Birch procedure; Trans-vaginal tape procedure

Definition
Surgeries for female stress incontinence help control involuntary urination by elevating the urethra and bladder.

Description

Open bladder and urethral surgeries are usually performed to prevent urine leakage associated with stress incontinence. Stess incontinence is an involuntary leakage of urine when laughing, coughing, sneezing, or lifting, which can be caused by deformity or damage to the urethra and bladder from decreased muscle tone. Multiple births, menopause, or other causes, may be to blame for this loss of muscle tone.

This problem is usually associated with a cystocele (the bladder sags into or even outside the vagina). The patient can often feel this during sexual intercourse, or may even see the bladder protruding outside of the vagina.

Surgery attempts to return the bladder and urethra to its normal position in the pelvis. This surgery can be performed in many different ways, depending on the patient’s anatomy and the severity of the problem.

There are 2 common ways of performing this surgery - through the abdominal wall or though the vagina. These procedures may either require general anesthesia or local or regional (spinal) anesthesia.

You will usually return from surgery with a Foley catheter or a suprapubic catheter in place. The urine may initially appear bloody, but this should gradually resolve.

The Foley or suprapubic catheter may be removed several days after surgery, when you are able to completely empty your bladder. Occasionally, the catheter will remain in place for as long as 3 months, depending on the person’s ability to empty the bladder completely.

Indications
Repair of the bladder and urethra may be recommended for treatment of stress incontinence (inability to prevent urine leakage when coughing, sneezing, laughing, jumping, walking, sitting, or standing).

Risks
Risks for any anesthesia are:

     
  • Reactions to medications  
  • Problems breathing

Risks for any surgery are:

     
  • Bleeding  
  • Infection

Expectations after surgery
This surgery can be very helpful for patients with stress incontinence.

Convalescence
The amount of time it takes to recover from surgery depends on the individual. Based on an evaluation of your health status prior to surgery, your health care provider can give you a good estimate of your recovery time.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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