Urethral suspension is a surgery to reduce or correct stress incontinence in women. This process uses stitches to support the bladder and urethra, the tube that carries urine from the bladder to the outside of the body.
Female Bladder and Urethra
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is uncontrolled leaking of urine. Muscles in the pelvis support the bladder and urethra. When these muscles are weakened these structures can fall out of position. This makes it difficult to prevent urine leakage from the bladder when there is pressure on bladder, like coughing. The vaginal wall is also close to the bladder and urethra. If the vagina is in a weak position it can also make it difficult for the bladder and urethra to work properly.
A bladder suspension lifts the bladder by securing it to nearby pelvic structures like to the pelvic bone. Lifting the bladder makes it easier for the bladder to close when it should to stop urine leakage into the urethra.
Complications are rare, but no procedure is completely free of risk. If you are planning to have a urethral suspension, your doctor will review a list of possible complications, which may include: BleedingInfectionReactions to anesthesiaInability to urinateContinued incontinence or recurrence of the problemDamage to other nearby organs or blood vesselsPain, such as during sexual intercourse
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as: SmokingDrinkingChronic disease such as diabetes or obesity
A series of tests will be done to determine the cause of incontinence. Surgery is only considered after other nonsurgical treatments have been tried. The results from the tests may also be used to prepare for surgery.
Leading up to surgery: Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.Arrange for a ride home from the hospital.Do not eat or drink anything after midnight the night before.
The choice of anesthesia will depend on the doctor, your specific procedure, your medical history, and your preferences. You may receive one of the following: Spinal anesthesia—to numb your lower body but you will be awake.
General anesthesia—you will be asleep.
The exact steps to the surgery will depend on your overall health and amount of support that is needed. Options for the doctor to gain access to the area include: Open procedure—An incision is made in the abdomen. The doctor will be able to view the area.Laparoscopic procedure—2-3 small incisions will be made in the naval and above the pubic hairline. Small instruments can be inserted through these incisions to complete the procedure.Transvaginal procedure—A small incision is made in the front vaginal wall.
Once the area is available sutures will be made to secure the organs to the pelvis. Sutures will be made in the neck of the bladder, the urethra and the vaginal wall. These sutures will then be anchored to the strong ligaments on the front of the pelvis. The sutures will be set to lift and support the structures. Once the sutures are in place the doctor will test to make sure the structures are in the desired position. After the placement is confirmed the sutures will be closed with sutures or surgical glue.
After surgery, you will be monitored in a recovery room. A catheter will be in place to allow the urinary tract to rest and drain the urine.
Anesthesia will block pain during the surgery. After surgery, you may experience some pain or soreness. You will be given
to relieve discomfort.
You may be sent home the same day if there are no complications.
The catheter will be removed once urine is passing as expected. Walking will be encouraged early to promote healing and decrease the risk of certain complications.
During your stay, the hospital staff will take steps to reduce your chance of infection such as: Washing their handsWearing gloves or masksKeeping any incisions covered
There are also steps you can take to reduce your chances of infection such as: Washing your hands often and reminding visitors and healthcare providers to do the sameReminding your healthcare providers to wear gloves or masksNot allowing others to touch incisions
There will be some activity limits after the procedure. Lifting and strenuous exercise will be limited for 6 weeks.
After you leave the hospital, contact your doctor if any of the following occurs: Signs of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or any discharge from the incision sitePain that you cannot control with the medications you have been givenCough, shortness of breath, or chest painSevere nausea or vomitingTrouble urinatingPain, burning, urgency, or frequency while urinating
In case of an emergency, call for emergency medical services right away.
Bladder and Urethral surgeries. Intermountain Healthcare website. Available at: http://intermountainhealthcare.org/ext/Dcmnt?ncid=520693119. Accessed May 27, 2015.
FAQ mid-urethral slings for stress urinary incontinence. Society of Urodynamics Female Pelvic Medicine and Urogenital Reconstruction website. Available at: http://www.sufuorg.com/docs/news/Patient-FAQs-MUS-for-posting.aspx. Accessed May 27, 2015.
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http://www.urologyhealth.org/urology/index.cfm?article=33. Updated January 2011. Accessed October 27, 2014.
Surgical mesh. US Food and Drug Administration website. Available at:
http://www.augs.org/p/cm/ld/fid=163. Updated January 4, 2012. Accessed October 27, 2014.
Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at:
http://www.nafc.org/bladder-bowel-health/types-of-incontinence/stress-incontinence/surgical-treatment-for-female-stress-urinary-incontinence/. Accessed October 27, 2014.
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Last reviewed May 2015 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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