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Also known as
Open retropubic colposuspension, Marshall-Marchetti-Krantz (MMK) procedure, Laparoscopic retropubic colposuspension, Needle suspension, Burch colposuspension
Definition
Retropubic suspension is a surgical procedure performed to treat stress urinary incontinence (SUI), which is the involuntary leakage of urine during activities that increase abdominal pressure, such as laughing, coughing, sneezing, lifting, or exercising. The surgery aims to elevate and support the bladder neck and urethra, thereby improving their ability to close and prevent urine leakage. This is achieved by suturing the bladder neck, a portion of the vaginal wall, and the urethra to the bones and ligaments within the pelvis. The procedure can be performed either through open surgery, involving an incision in the lower abdomen, or laparoscopically, using smaller incisions and a laparoscope to visualize the internal organs.¹
Clinical Context
Retropubic suspension is primarily used to treat stress urinary incontinence (SUI) in women, particularly when conservative treatments like bladder retraining, Kegel exercises, or medications have been ineffective. Patient selection typically involves individuals experiencing significant urine leakage during physical activities due to a sagging bladder neck and urethra. The most common procedure for retropubic suspension is the Burch colposuspension, where the vaginal wall is attached to Cooper’s ligament near the pubic bone to provide support. The surgery can be performed as open surgery (larger incision) or laparoscopic surgery (smaller incisions). Recovery time varies, with laparoscopic surgery allowing a return to work in 1-2 weeks and open surgery requiring 2-4 weeks. Full recovery, including avoiding heavy lifting, typically takes at least 6 weeks. Most women experience a significant reduction in SUI symptoms, with cure rates around 90% in the first year and 70% after five years. Potential risks include difficulty urinating post-surgery, new symptoms of urgency, internal bleeding, infection, injury to organs, or pelvic organ prolapse.²