URINARY INCONTINENCE RETROPUBIC SUSPENSION

urinary incontinence retropubic suspension
Retropubic suspension procedures are used to treat female stress incontinence caused by urethral hypermobility. The aim of surgery is to elevate and fix the bladder neck and proximal urethra in a retropubic position, to support the bladder neck, and regain continence. Contraindicated in the presence of significant intrinsic sphincter deficiency (ISD).

Types of surgery
Surgery is considered after conservative methods have failed—3 main types of operation. All done via a Pfannenstiel or lower midline abdominal incision to approach the bladder neck and develop the retropubic space. Better results are seen in patients with pure stress incontinence and primary repair (as opposed to redo surgery).

Marshall Marchetti Krantz (MMK) procedure
Sutures are placed either side of the urethra around the level of the bladder neck and then tied to the hyaline cartilage of the pubic symphysis. Short-term success is about 90%,7 but declines over time. Complications: osteitis pubis (3%), typically presenting up to 8 weeks post-op with pubic pain radiating to the thigh. Treatment is with simple analgesia, bed rest, and steroids.

Burch colposuspension
Requires good vaginal mobility, to allow vaginal wall to be elevated and attached to the lateral pelvic wall where the formation of adhesions over time secures its position. Paravaginal fascia is exposed and approximated to the iliopectineal (Cooper's) ligament of the superior pubic rami. Initial success rates are 90%.7 Better long-term results compared to other retropubic repairs. A laparoscopic approach can also be performed, but long-term results have proven to be poor.

Vagino-obturator shelf/paravaginal repair
Sutures are placed by the vaginal wall and paravaginal fascia, and then passed through the obturator fascia to attach to part of the parietal pelvic fascia below the tendinous arch (arcus tendoneus fascia). Cure rates are up to 85%.

Complications of retropubic suspension procedures
urinary retention (5%); bladder overactivity; vaginal prolapse.