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Operation: Retropubic suspension of neck of bladder

Insurance code: M5220

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation A retro-pubic suspension of the bladder neck is usually carried out to cure stress incontinence but is sometimes carried out to improve vaginal prolapse.

Description of procedure
A catheter is placed in the bladder to drain off all the urine and protect the bladder from surgical damage. The abdominal cavity is opened through a transverse supra-pubic (bikini line) or midline vertical abdominal incision. The space around the bladder is exposed and the anatomy is defined. A series of 3 sutures are inserted on each side to elevate the front wall of the vaginal to one of the ligaments behind the pubic bone. Blood vessels are secured to prevent bruising. The sutures are tied to elevate the vagina and the bladder base. A supra-pubic catheter is placed in the bladder from the front to drain urine off until full bladder emptying has returned to normal.

Anaesthetic These operations are usually carried out under general anaesthetic.

Length of stay A ‘bikini’ line incision normally allows for a four night stay and a vertical midline incision normally requires a five night stay.

Post-operative management The catheter is normally removed the following day. The IV fluid line is left in place until oral fluids are tolerated. The painkilling pump is kept in place until it is no longer required. Stitches or skin staples are normally removed the day of discharge from hospital.

Potential complications
Complications at the time of surgery include peri-operative bleeding, and damage to structures such as bladder and bowel. These complications are rare but require corrective surgery immediately or as soon as a problem is recognised. Venous thrombosis (DVT) can follow any pelvic surgery. Stockings are therefore worn and heparin injections given each day to reduce the risk. Early mobilisation and early discharge from hospital reduce the risk of thrombosis. Long term complications include the development of a posterior vaginal prolapse called an enterocele, difficulty emptying the bladder completely, urinary urgency and an increased incidence of urinary tract infections.

Post-operative consultation
A routine appointment is normally booked for six weeks to ensure the vagina is well healed although other appointments may be necessary to ensure the post-operative course goes smoothly.

Other considerations
These operations have now largely been replaced with simpler less complicated procedures such as trans-obturator tape and tension-free vaginal tape procedures. They are therefore reserved for individual cases where the simpler manoeuvres are impractical.

Other websites

Guidelines on management of urinary incontinence. Requires Adobe acrobat reader.

Good information from the Royal College of Obstetricians and Gynaecologists on surgery for urinary incontinence.