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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 (belly) wall. This surgery can be done by making one big incision (open surgery) or several small incisions (laparoscopic surgery).

Burch colposuspension is the most common procedure used for retropubic suspension. The vaginal wall is attached to a ligament (Cooper's ligament) next to the pubic bone.

What To Expect

These procedures involve abdominal surgery, so hospitalization is required. To allow healing of the urinary tract, a catheter is placed into the bladder through the urethra (or belly 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. The time it takes for you to recover depends on if you had open or laparoscopic surgery.

If you had laparoscopic surgery, you will probably be able to go back to work and most of your usual activities in 1 to 2 weeks. If you had open surgery, it may take longer, about 2 to 4 weeks. For either surgery, you may need 4 to 6 weeks to fully recover. Try to avoid heavy lifting and strenuous activities. These might put extra pressure on your bladder.

The amount of pain you have 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.

Women who have laparoscopic surgery usually have shorter recovery times. They may also have less pain after surgery, have shorter hospital stays, and return to normal activities faster than women who have open surgery.footnote 1

Many women have some constipation after this surgery. You can try some things to avoid constipation:

  • Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
  • Drink plenty of fluids, enough so that your urine is light yellow or clear like water.
  • Take a fiber supplement, such as Citrucel or Metamucil, every day if needed. Read and follow all instructions on the label.
  • Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when having a bowel movement.

Tell your doctor if you still have constipation after you have tried these methods.

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.

For stress incontinence, doctors have been doing Burch colposuspension surgeries longer than sling surgeries. Many studies have been done on the Burch colposuspension surgery. About 9 out of 10 women are cured ("dry") during the year after surgery. After 5 years, about 7 out of 10 women are still "dry."footnote 2

Risks

Complications of retropubic surgery may include:

  • Difficulty urinating after surgery.
  • New symptoms of urgency or urge incontinence.
  • Internal bleeding.
  • Infection at the incision site.
  • Injury to an organ (such as the bladder, urethra, or ureters).
  • Pelvic organ prolapse (usually, enterocele).

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. The catheter may be uncomfortable. And it increases the risk of getting 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 I 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.

References

Citations

  1. Ellis DN, et al. (2006). Laparoscopic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews (3).
  2. Lapitan MCM, et al. (2009). Open retropubic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews (4).

Credits

ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Avery L. Seifert, MD, FACS - Urology

Current as ofOctober 6, 2017


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