Definition:
Surgeries for female stress incontinence help control involuntary leakage of urine by supporting the structure of the urethra and bladder.
Alternative Names:
Urethral suspension; Marshall-Marchetti-Krantz operation; MMK; Pubovaginal sling; Burch procedure; Trans-vaginal tape procedure; TVT procedure; Vesicourethral suspension; Transobturator tape procedure; TOT procedure
Description:
Open bladder and urethral surgeries are usually performed to prevent urine leakage that occurs with stress incontinence. Stress incontinence is an involuntary leakage of urine that occurs when laughing, coughing, sneezing, or lifting. The condition can be caused by deformity or damage to the urethra, bladder, or pelvic muscles. Multiple births and menopause can cause a loss of muscle tone in the bladder area. The bladder may sag into or outside the vagina. You may feel this during sexual intercourse. You may see the bladder protruding outside of the vagina. Surgery is done to try and return the bladder and urethra to their normal position. Surgery may require general anesthesia, local anesthesia, or regional (spinal) anesthesia. There are two common ways of performing stress incontinence surgery: through the abdominal wall or though the vagina. Less invasive approaches, such as through the vagina, have become more popular than traditional open approaches because of their effectiveness. You may return from surgery with a Foley catheter or a suprapubic catheter in place. The urine may appear bloody at first. This should go away over time. How long the Foley or suprapubic catheter stays in place depends on your ability to completely empty your bladder. It may be removed several days after surgery. In rare cases, it may stay in place for a longer period of time. Another treatment option uses a tube to view the bladder area (cystoscope) and inject a bulking agent such as collagen into the urethra. Such injections help make the opening of the urethra smaller, which prevents urine loss.
Why the Procedure Is Performed:
Repair of the bladder and urethra may be recommended for treating stress incontinence.
References:
Keegan PE, Atiemo K, Cody J, McClinton S, Pickard R. Periurethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev. 2007;(3):CD003881. Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356:2143-2155. Rogers RG. Clinical practice: urinary stress incontinence in women. N Engl J Med. 2008;358:1029-1036.
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