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Also known as
Open retropubic colposuspension, Marshall-Marchetti-Krantz (MMK) procedure, Laparoscopic retropubic colposuspension, Needle suspension, Burch colposuspension, Retropubic urethropexy, Laparoscopic Burch procedure, Laparoscopic bladder neck suspension
Definition
Laparoscopic retropubic surgery, also known as laparoscopic colposuspension or laparoscopic Burch procedure, is a minimally invasive surgical approach used to treat stress urinary incontinence in women.¹ The procedure involves making small incisions in the abdomen through which a laparoscope (a thin, telescope-like instrument with a camera) and surgical instruments are inserted to access the retropubic space.² During the surgery, sutures are placed through the tissue next to the vagina to help support the urethra and bladder neck, attaching them to Cooper’s ligament.³ This stabilizes the urethrovesical junction in its normal anatomical position, preventing urinary leakage during physical exertion.⁴
The laparoscopic approach offers several advantages over traditional open surgery, including better visualization, shorter hospital stays, less postoperative pain, better cosmetics, and faster recovery to normal daily activities.⁵ The procedure is typically performed under general anesthesia and takes approximately 2 hours to complete.⁶ The extraperitoneal approach is most commonly used, which minimizes the risk of intra-abdominal injury and is associated with a shorter learning curve.⁷
Clinical Context
Laparoscopic retropubic surgery is primarily used to treat stress urinary incontinence (SUI) in women, which is characterized by involuntary leakage of urine during physical exertion such as coughing, sneezing, laughing, or exercise.¹ The procedure is indicated for women who have failed conservative management approaches including pelvic floor muscle training, incontinence pessaries, and urethral bulking agents.²
Patient Selection Criteria:
- Women with urodynamically proven stress urinary incontinence due to urethral hypermobility
- Patients who have failed conservative management approaches
- Women with adequate vaginal mobility and capacity
- Patients planning to have a simultaneous abdominal-pelvic procedure (e.g., hysterectomy)
- Women who want to avoid both fascial harvest and mesh procedures³
Contraindications:
- Patients with type III stress urinary incontinence (a fixed, nonfunctioning proximal urethra)
- Patients requiring correction of central defect cystocele, rectocele, or introital deficiency
- Patients who have had more than one previous anti-incontinence operation
- Women who have not completed childbearing
- Patients who are not fit for surgery⁴
Surgical Procedure:
The surgical procedure is performed through an extraperitoneal approach. The patient is placed under general anesthesia in a dorsal lithotomy position. Small incisions (typically 0.5-1.5 cm) are made in the abdomen for the insertion of trocars. A laparoscope is introduced to visualize the retropubic space. The bladder is mobilized, and the periurethral fat is cleared from the pubocervical fascia. Cooper’s ligaments are exposed and cleansed. Two paravaginal non-absorbable sutures are placed on each side between the anterior vaginal wall and Cooper’s ligament, 2 cm laterally on each side of the urethra and 2 cm distal to the bladder neck. This lifts and stabilizes the bladder neck and proximal urethra in their normal anatomical position.⁵
Expected Outcomes:
Short-term success rates (1 year) for laparoscopic retropubic suspension are comparable to open procedures, with cure rates of approximately 85-90%.⁶ However, long-term follow-up shows a decline in success rates over time. At 3-year follow-up, approximately 68-70% of patients report complete or almost complete cure, 11% report improvement, and 20% report failure.⁷ The procedure offers advantages of shorter hospital stay, less postoperative pain, better cosmetics, and faster recovery compared to open surgery.⁸
Complications:
Potential complications include infection, bleeding, risks of anesthesia, blood clots, damage to nerves, muscles, bladder, or nearby pelvic structures, trouble urinating, and urinary urgency.⁹ The most common intraoperative complication is lower urinary tract injury, with bladder injury occurring at an incidence of 2.17-18%, more common in patients with prior pelvic surgery.¹⁰ Development of overactive bladder after the procedure occurs at an incidence of 2.8%-8%, and the incidence of postoperative permanent or transient urinary retention is low (1.8%).¹¹