Urethral Suspension—Retropubic Suspensions

by Patricia Kellicker, BSN

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, which gives more resistance against leakage. This will stop the uncontrolled leaking of urine.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

Bleeding
Infection
Reactions to anesthesia
Inability to urinate
Continued incontinence or recurrence of the problem
Damage to other nearby organs or blood vessels
Pain such as during sexual intercourse

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

Smoking
Drinking
Chronic disease such as diabetes or obesity

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 medications up to one week before the procedure.
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 Procedure

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

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?

1-1.5 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 discomfort.

Average Hospital Stay

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. You may be up and walking the same day or the day after surgery.

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

Washing their hands
Wearing gloves or masks
Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

Washing your hands often and reminding visitors and healthcare providers to do the same
Reminding your healthcare providers to wear gloves or masks
Not allowing others to touch your incisions

At Home

Avoid lifting and strenuous exercise for 6 weeks after surgery. This will allow healing to take place. Do not return to sexual activity or use tampons until your doctor says it is okay to do so.

Call Your Doctor

Contact your doctor if your recovery is not progressing as expected or you develop complications such as:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Pain that you cannot control with the medications you were given
Cough, shortness of breath, or chest pain
Severe nausea or vomiting
Trouble urinating
Pain, burning, urgency, or frequency while urinating

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org

The Canadian Continence Foundation
http://www.canadiancontinence.ca

References:

Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at: https://www.nafc.org/resource-center/surgical-treatment-for-female-stress-urinary-incontinence. Accessed December 18, 2017.

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(3):1012-1016.

Urinary incontinence. Urology Care Foundation website. Available at:
...(Click grey area to select URL)
Accessed December 18, 2017.

Urogynecologic surgical mesh. US Food & Drug Administration website. Available at: https://www.fda.gov/downloads/medicaldevices/safety/alertsandnotices/ucm262760.pdf. Accessed December 18, 2017.

6/2/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.

Last reviewed November 2018 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 12/20/2014

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