Home > Your Health > Medical Procedures > Urethral Suspension

Urethral Suspension by Patricia Kellicker, BSN

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

Stress incontinence is one of the many causes of uncontrolled leaking of urine. Urethral suspension is a surgery to correct incontinence in women.

The incontinence is most often caused by weakening of the pelvic muscles that normally keep the bladder in position. The muscles may be weakened by:

Pregnancy
Childbirth
Menopause
Previous pelvic surgery
Lack of physical activity

Female Bladder and Urethra

Reasons for Procedure

The goal of this surgery is to provide extra support to the urethra, giving more resistance against leakage. This will stop the uncontrolled leaking of urine.

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
Erosion of the mesh material used during the procedure
Pain (eg, during sexual intercourse)

Your overall health will determine if you are at risk for complications. Talk to your doctor about any factors that may increase your risk.

What to Expect

Prior to Procedure

Your doctor will try to find out why you are leaking urine through some or all of the following:

Medical history—information about medications, illnesses, number of pregnancies, and previous surgeries; pattern of leaking and how it is affecting your life.
Urine sample—to look for the presence of infection or other problems
Physical exam—includes a rectal and vaginal exam
Additional testing may be ordered to evaluate bladder function and urine flow, such as:
- Urodynamic testing (urine flow studies)—a temporary catheter is placed to study bladder function
- Cystoscopy—a procedure done to view the inside of the bladder.

Leading up to surgery:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
Arrange for a ride home from the hospital.
Do not eat or drink anything after midnight the night before.

Anesthesia

You may receive a spinal anesthetic to numb your lower body. General anesthesia may also be used, in which case you will be asleep.

Description of the Procedure

There are several different types of suspension surgery:

Tension-Free Vaginal Tape Procedure

Two incisions will be made in the vagina. A nylon mesh-like tape will be inserted in these incisions to form a hammock. This will give support to the urethra, closing the urethra during a cough or sneeze. No sutures will be needed to hold the tape in place. The mesh will hold onto the surrounding tissue until scar tissue grows into it.

Sling Procedure

This procedure will require one or two small incisions in the abdominal wall and in the vagina. The incisions will be made just above the pubic bone. Like the vaginal tape procedure, a hammock or sling will be made under the urethra. The sling will close the urethra when pushed down by a sneeze, cough, or other stressors. This will prevent the incontinence. The sling can be made out of a synthetic material or tissue from your own body.

Retropubic Suspensions

An incision will be made in the lower abdomen. Sutures will be placed near the bladder and urethra. The threads of the suture will then be secured to the pelvic bone or other structures in the pelvis. This supports the bladder by forming a cradle for it.

Transvaginal Suspensions

This version is done through the vagina. Sutures will be placed near the bladder neck and urethra. The threads will then be tied to the abdominal wall or the pelvic bone. This supports the bladder by placing it back into its normal position.

Laparoscopic Bladder Suspension

This procedure uses 2-3 small incisions. Special instruments will be used to tie the bladder to the pelvic bone. A special scope is used to view the area for surgery.

Immediately After Procedure

After surgery, you will be monitored in a recovery room. You will most likely have a catheter in place to drain your urine.

How Long Will It Take?

The surgery usually takes about 1-1½ 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 the discomfort.

Average Hospital Stay

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

Postoperative Care

At the Hospital

At first, your urine may look bloody. 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.

At Home

Avoid lifting and strenuous exercise for six weeks after surgery. This will allow healing can take place.

To help ensure a smooth recovery, follow your doctor's instructions.

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 can't control with the medications you've 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 911.

RESOURCES:

National Kidney and Urologic Diseases Clearinghouse http://kidney.niddk.nih.gov/
Urology Health.org http://www.urologyhealth.org/

CANADIAN RESOURCES:

The Canadian Continence Foundation http://www.continence-fdn.ca/
Canadian Urological Association http://www.cua.org/

References:

Surgeries for female stress incontinence. US National Library of Medicine, Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/print/ency/article/002992.htm. Updated May 2008. Accessed October 20, 2009.
The surgical management of female stress urinary incontinence. The American Urological Association website. Available at: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/fsuimainrpt.pdf. Published 1997. Accessed October 20, 2009.
Surgical management of urinary incontinence. American Urological Association website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=03&topic=133. Updated 2003. Accessed October 20, 2009.
Surgical mesh. US Food and Drug Administration website. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm142636.htm. Updated October 8, 2009. Accessed October 20, 2009.
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/. Updated July 2009. Accessed October 20, 2009.
Treatment and prevention. The American Urogynecologic Society website. Available at: http://www.mypelvichealth.org/TreatmentPrevention/BladderControlProblems/TreatmentOptions/Surgery/tabid/120/Default.aspx. Accessed October 20, 2009.
Townsend MK, Danforth KN, Rosner B, Curhan GC, Resnick NM, Grodstein F. Physical activity and incident urinary incontinence in middle-aged women. J Urol. 2008;179:1012-1016; discussion 1016-1017.
Wein AJ. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2007: chap 67.

Last reviewed October 2009 by Adrienne Carmack, MD

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