Retropubic Suspension for Urinary Incontinence

Written by Amber Erickson Gabbey | Published on June 11, 2012
Medically Reviewed by George Krucik, MD

What Is Retropubic Suspension?

Retropubic suspension is a surgical procedure used to treat urinary incontinence (the inability to control your bladder). This specific procedure helps control urine leakage that is considered stress incontinence. This means that a leakage of urine occurs when you laugh, sneeze, exercise, cough, or lift objects.

During the surgery, a doctor adjusts the positioning of the urethra and bladder neck (where the urethra connects to the bladder) so that less urine can pass through. If you have stress incontinence, a retropubic suspension can greatly reduce your discomfort and prevent embarrassment.

Urinary Incontinence Basics

Urinary incontinence occurs when you lose control of your bladder. It is more common in women than men, although anyone can have the condition. Its likelihood also increases with age and with certain risk factors, such as smoking or being overweight.

Urinary incontinence is not a disease in itself. Rather, it is a symptom of lifestyle choices, medical issues, or physical problems.

Urinary incontinence could be caused by:

  • medications
  • over hydrating
  • alcohol, caffeine, and other foods that irritate the bladder (such as those with high levels of spice, sugar, and acid)
  • urinary tract infection (UTI)
  • constipation
  • pregnancy and childbirth
  • hysterectomy
  • changes with age, such as menopause
  • enlarged prostate or prostate cancer
  • bladder cancer neurological disorders (such as Parkinson’s disease, multiple sclerosis, stroke, and brain tumor)
  • obstruction (by stones in the kidney, bladder, or ureters)

Urinary incontinence ranges from leaking a bit of urine while laughing or coughing, to having the urge to urinate when you don’t need to. It could also mean needing to urinate frequently and barely making it to a toilet in time. For many, it is just an inconvenience, but it could be a sign of a more serious issue.

How Is Urinary Incontinence Treated

The treatment options for urinary incontinence are vast and varied. As the cause of incontinence is different for each individual, you will have your own unique treatment plan.

Usually, your doctor will try behavioral treatments, such as bladder retraining and kegel exercises, before suggesting more invasive treatments, such as surgery.

Retropubic suspension is only a treatment option for those suffering from stress incontinence. The surgery is best for those who were not able to successfully treat their urinary incontinence with kegels or bladder retraining exercises.

What to Expect and How to Prepare

Be sure to tell your doctor about any medications, supplements or herbs you are taking before the procedure. You may be advised to stop taking certain medications, including pain relievers, several days beforehand.

On the day of the procedure, you may not be able to eat or drink for up to 12 hours prior to your appointment. You may also be expected to shave your pubic area. Your doctor will tell you everything you need to do—or refrain from doing— before the procedure.

Retropubic suspension can be performed in either your doctor’s office or hospital. You will be under anesthesia and should not feel any pain. However, while receiving the anesthesia, you may feel some pain from the prick of the needles. You may experience some pain, soreness, or stiffness upon waking after the procedure. Your doctor will help with any aftercare requirements.

The Retropubic Suspension Procedure

You will receive a general or a spinal anesthesia. This will numb the area so you will not feel any pain. The entire procedure should take around two hours.

Your doctor will make a small incision and then attach the bladder neck and urethra to your pelvis. Doing this lifts your bladder and urethra, allowing them to close easily and preventing urine from leaking.

The incision can be done in two ways. For open surgery, a cut is made in your lower abdomen and the doctor performs the surgery traditionally. In laparoscopic surgery, the incision is smaller and a tube is inserted through it. Your doctor uses a tube that is equipped with a camera and small instruments to sew your organs.

The main difference is that laparoscopic surgery is less invasive, requires a smaller incision, and may have a shorter recovery time. Your surgeon will decide which option is right for you.

Associated Risks

Risks of retropubic suspension surgery include:

  • bleeding
  • blood clots
  • infection
  • damage to urinary tract
  • problems with urination
  • worsening of urinary incontinence

After the Surgery and Long-Term Outlook

After the surgery, you may go home with a catheter still in place. If this is the case, you will be taught what you need to do before you leave the hospital. Be sure to ask any questions about aftercare at that point.

It is common to have a decrease in urine leakage after this surgery. However, it may not fix the problem completely and the incontinence may reoccur in the future.

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Article Sources:

  • Culligan, P. J. and Heit, M. (2000). “Urinary incontinence in women: Evaluation and management.” American Family Physician, 62(11), p. 2433-2444. Retrieved June 8, 2012, from http://www.aafp.org/afp/2000/1201/p2433.html

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