Definition

Urethral suspension is a surgical procedure used to treat stress [3] incontinence [4] in women. Stress incontinence [5] is an uncontrolled leaking of urine. Stress, in this case, means physical stress [3] on the bladder and urethra (the short tube from the bladder to above the vagina that carries urine). Types of physical stress [3] that can cause this leakage include coughing, laughing, exercise [6], sneezing, or lifting. Approximately 85% of all stress [3] incontinence [4] occurs in women.


Parts of the Body Involved

Suspension surgery places the neck of the bladder and the urethra back into their normal position. The bladder neck is a muscle [7] fiber that joins the bladder to the urethra. Most women with stress [3] incontinence [4] have weakened pelvic muscles [7]. This weakening can be caused by pregnancy, childbirth [8] , menopause [9] , or previous pelvic surgery.


Reasons for Procedure

The goal of surgery is to return the bladder and urethra to their normal position. By repositioning them, they are better supported and don’t cause uncontrolled leaking of urine.


Risk Factors for Complications During the Procedure

Your overall health [10] at the time of surgery will determine if you are at risk for complications. Ask your surgeon about any possible complications.


What to Expect

Prior to Procedure

Prior to surgery, your doctor will try to find out why you are leaking urine. He or she will likely do the following:

  • Medical history—You will be asked about medications, illnesses, number of pregnancies, and previous surgeries. You will also be asked about your pattern of leaking, and how it is affecting your life.
  • Urine sample—Your urine may be tested for the presence of infection or other problems.
  • Physical exam—This includes a rectal and vaginal exam.
  • Additional testing may be ordered to evaluate bladder function and urine flow. This is called urodynamic testing and often involves temporary catheterization. The urologist will often perform a cystoscopy [11] at the same time to evaluate the inner anatomy of your bladder.

In the days leading up to surgery:

  • You will meet with an anesthesiologist to discuss your surgery.
  • Arrange for a ride home from the hospital.
  • Do not eat or drink anything after midnight before your surgery unless told otherwise by your doctor.
  • Plan on wearing comfortable clothing.

Anesthesia

Anesthesia may be epidural [12] or general, [13] depending upon the type of surgery performed.

Description of the Procedure

There are several different types of suspension surgery.

Tension-free Vaginal Tape Procedure

Two incisions are made above the pubic bone [7], and one in the vagina. A nylon mesh-like tape is used to form a hammock, and gives support to the urethra. This hammock closes the urethra when a cough or sneeze pushes it open. No sutures are needed to hold the tape in place as the mesh holds onto the surrounding tissue until scar tissue grows into the mesh.

Sling Procedure

This procedure is performed through an incision in the vagina. Like the vaginal tape procedure, a hammock or sling is made under the urethra that prevents incontinence [4] by closing the urethra when pushed down by a sneeze, cough, or other stressor. The sling can be made out of a synthetic material or using the body’s fascia, which is a strong material that surrounds muscle [7].

Pubovaginal Sling

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© 2008 Nucleus Medical Art, Inc.

Retropubic Suspensions

An incision is made in the lower abdomen. The surgeon places sutures (surgical threads) near the bladder neck and urethra. The threads are then secured to the pelvic bone [7] or other structures in the pelvis. This supports the bladder by forming a cradle for it.

Transvaginal Suspensions

The surgeon performs this procedure through the vagina, and through a small incision made in the lower abdomen. Sutures are placed near the bladder neck and urethra from the vagina and abdominal incision. The threads are then tied to the abdominal wall or the pelvic bone [7]. This supports the bladder by placing it back into its normal position.

Laparoscopic Bladder Suspension

This procedure uses 2-3 small incisions and special instruments to tie the bladder to the pelvic bone [7]. The surgeon uses a telescope to perform the surgery.

After Procedure

After surgery, you will be monitored in a recovery room until you are awake. You will most likely have a catheter in place to drain your urine. At first, your urine may look bloody, but this will resolve over time. When you are able to empty your bladder completely, the catheter will be removed. Depending upon the procedure, you may be up and walking the same day or the day after surgery. You will be advised to avoid strenuous activities and lifting for three months, so that sufficient healing can take place.

How Long Will It Take?

The surgery usually takes about 1 to 1½ hours.

Will It Hurt?

You will be given medications during your surgery so that you don’t feel any pain [14]. After surgery, you may experience some pain [14] or soreness, and will be given pain [14] medication to relieve the discomfort.

Possible Complications

Serious complications from this type of surgery are rare. As with any surgery, there is a small risk of bleeding and infection, as well as possible complications from anesthesia, including reactions to the type of anesthesia medication used, or breathing problems.

Complications specific to this surgery are:

  • Urine retention or the incomplete emptying of the bladder, can occur after surgery. In this case, a catheter is used to drain the urine from the bladder. Retention is usually temporary but may last a month or more in which case, patients are taught to drain their own bladder with a catheter.
  • Urge incontinence [4] or the leaking of urine before you can get to a bathroom, can sometimes develop after surgery.
  • With pubovaginal slings, there is a risk of erosion of the prosthetic tape through the vaginal wall, especially among older women with some degree of vaginal atrophy.
  • There is a risk of damaging the bladder and other adjacent organs in some procedures when passage of needles form the abdomen to the vagina is done to create the hammock.

Average Hospital Stay

Depending upon the type of surgery, you may be sent home the same day or stay in the hospital for 2-3 days.

Postoperative Care

Your surgeon will give you specific instructions for home. You will be instructed to avoid lifting and strenuous exercise [6] for three months after surgery to allow your body to heal.


Outcome

Urethral suspension surgery cures or improves stress [3] incontinence [4] in the majority of cases.


Call Your Doctor If Any of the Following Occurs

Once you leave the hospital, it is essential that you monitor your recovery. Call your doctor at once if you experience any of the following:

  • Redness or swelling at incision
  • Increasing pain [14]
  • Bleeding or discharge from incision
  • Cough, shortness of breath, or chest pain [14]
  • Severe nausea or vomiting
  • Pain, burning, urgency, or frequency while urinating
  • Fever or chills