Marshall-Marchetti-Krantz procedure

Definition

The Marshall-Marchetti-Krantz procedure surgically reinforces the bladder neck in order to prevent unintentional urine loss.

Purpose

The Marshall-Marchetti-Krantz procedure is performed to correct stress incontinence in women, a common result of childbirth and/or menopause. Incontinence also occurs when an individual involuntarily loses urine after pressure is placed on the abdomen (like during exercise, sexual activity, sneezing, coughing, laughing, or hugging).

Precautions

In some women, stress incontinence may be controlled through nonsurgical means, such as:

• kegel exercises (exercises that tighten pelvic muscles)
• biofeedback (monitors temperature and muscle contractions in the vagina to help incontinent patients control their pelvic muscles)
• bladder training (behavioral modification program used to treat stress incontinence)
• medication
• inserted incontinence devices

Each patient should undergo a full diagnostic workup to determine the best course of treatment.

Description

The Marshall-Marchetti-Krantz procedure, also known as retropubic suspension or bladder neck suspension surgery, is performed by a surgeon in a hospital setting. The patient is placed under general anesthesia, and a long, thin, flexible tube (catheter) is inserted into the bladder through the narrow tube (urethra) that drains the body's urine. An incision is made across the abdomen, and the bladder is exposed. The bladder is separated from surrounding tissues. Stitches (sutures) are placed in these tissues near the bladder neck and urethra. The urethra is then lifted, and the sutures are attached to the pubic bone itself, or to tissue (fascia) behind the pubic bone. The sutures support the bladder neck, helping the patient gain control over urine flow.

Preparation

A complete evaluation to determine the cause of incontinence is critical to proper treatment. A thorough medical history and general physical examination should be performed on candidates for the Marshall-Marchetti-Krantz procedure. Diagnostic testing may include x rays, ultrasound, urine tests, and examination of the pelvis. It may also include a series of urodynamic testing exams that measure bladder pressure and capacity, and urinary flow.

Patients undergoing a Marshall-Marchetti-Krantz procedure must not eat or drink for eight hours prior to the surgery.

Aftercare

Recovery from a Marshall-Marchetti-Krantz procedure requires two to six days of hospitalization. The catheter will be removed from the patient's bladder once normal bladder function resumes. Patients are advised to refrain from heavy lifting for four to six weeks after the procedure.

Patients should contact their physician immediately if they experience fever, dizziness, or extreme nausea, or if their incision site becomes swollen, red, or hard.

Risks

The Marshall-Marchetti-Krantz procedure is an invasive surgical procedure and, as such, it carries risks of infection, internal bleeding, and hemorrhage. There is also a possibility of permanent damage to the bladder or urethra. The urethra may become scarred, causing a permanent narrowing, or stricture.

Normal results

Approximately 85% of women who undergo the Marshall-Marchetti-Krantz procedure are cured of their stress incontinence.

BOOKS

Blaivas, Jerry. Conquering Bladder and Prostate Problems: The Authoritative Guide for Men and Women. New York: Plenum, 1998.

ORGANIZATIONS

American Foundation for Urologic Disease. 1128 NorthCharles St., Baltimore, MD 21201. (800) 242-2383. <http://www.afud.org>.

National Association for Continence. P.O. Box 8310, Spartan-burg, SC 29305-8310. (800) 252-3337. <http://www.nafc. org>.

National Kidney and Urologic Diseases Information Clearing-house (NKUDIC). 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5388. <http://www.niddk.nih.gov/health/urolog/pubs/kuorg/kuorg.htm>.

Paula Anne Ford-Martin

KEY TERMS

Biofeedback—Biofeedback training monitors temperature and muscle contractions in the vagina to help incontinent patients control their pelvic muscles.

Bladder training—A behavioral modification program used to treat stress incontinence. Bladder training involves putting the patient on a toilet schedule, and gradually increasing the time interval between urination.

Catheter—A long, thin, flexible tube. A catheter is used to drain the bladder of urine during a Marshall-Marchetti-Krantz procedure.

Kegel exercises—Exercises that tighten the pelvic floor muscles. Kegel exercises can assist some women in controlling their stress incontinence.

Urethra—The narrow tube, leading from the bladder that drains the body's urine.