Bladder neck suspension surgery is a procedure designed to address bladder control issues. It involves providing support to the bladder neck and urethra, which are structures involved in urine flow. This surgery aims to restore proper function and alleviate symptoms associated with pelvic floor weakness.
Understanding the Procedure
Bladder neck suspension surgery provides structural support to the bladder neck and urethra, the area where the bladder connects to the urethra. The urethra is the tube that carries urine out of the body. The primary goal is to treat stress urinary incontinence (SUI), a condition characterized by involuntary urine leakage.
SUI occurs when there is increased pressure on the bladder, such as during coughing, sneezing, laughing, exercising, or lifting heavy objects. This leakage happens because the tissues supporting the urethra become weakened, preventing the urethral sphincter, a muscle around the bladder’s opening, from closing properly. Factors like childbirth, menopause, and previous pelvic surgeries can contribute to the weakening of these supportive tissues and pelvic floor muscles.
Different Surgical Approaches
Several surgical approaches exist for bladder neck suspension, each differing in how support is provided. The Burch colposuspension involves placing sutures in the vaginal tissue near the bladder neck and attaching them to ligaments near the pubic bone. This action elevates the vagina and offers support to the urethra, aiming to reduce or stop urine leakage.
Another method is the Marshall-Marchetti-Krantz (MMK) procedure, which attaches tissues near the bladder neck and urethra directly to the pubic bone. Both the Burch and MMK procedures are performed via an abdominal incision, although laparoscopic (keyhole) approaches are also used for the Burch procedure, offering benefits like shorter hospital stays and faster recovery. While needle bladder neck suspension procedures exist, they have shown lower cure rates and higher failure rates compared to open abdominal retropubic suspension.
What to Expect During and After Surgery
Before surgery, patients undergo a pre-assessment to evaluate their general health and readiness. They are admitted to the hospital on the day of surgery. Patients receive a blood-thinning injection before and after surgery until mobile, along with intravenous antibiotics during anesthesia.
The surgery is performed under general anesthesia, where the patient is asleep, or spinal anesthesia, which numbs the body from the waist down. During an open procedure, a horizontal incision is made in the lower abdomen to access the bladder and urethra. Sutures are placed in the vaginal tissue adjacent to the urethra and secured to the supportive ligaments or pubic bone. A cystoscopy, a telescopic examination of the bladder, is performed to ensure no damage to the lower urinary tract.
After surgery, patients may have an intravenous drip and a temporary catheter, typically removed within a few days. Hospital stays range from 3 to 5 days, depending on the procedure and individual recovery. Recovery at home involves managing discomfort with pain medication for several days. Patients should avoid driving for at least three weeks, and heavy lifting for approximately 6 weeks to allow for proper healing and prevent undue stress on the surgical repair. Sexual intercourse should also be avoided for at least a month.
Risks and Long-Term Outlook
Bladder neck suspension carries risks, though complications are generally uncommon. These include bleeding, urinary tract infections, and difficulty emptying the bladder. Less common risks include recurrence of stress incontinence, new onset urgency, pain during sexual intercourse, or damage to nearby blood vessels or organs. Some patients might experience temporary difficulty urinating or urinary retention after the procedure.
Bladder suspension surgery demonstrates a high success rate in improving or resolving SUI symptoms. The long-term success of the Burch colposuspension has been historically regarded as quite good, with studies indicating an 85% long-term success rate for treating stress incontinence. However, symptoms can recur over time, and a second surgical bladder suspension might be considered. The durability of the procedure can vary, and avoiding heavy lifting, weight gain, and smoking can help maintain the long-term effectiveness of the repair.