Definition and Overview

Also referred to as Burch urethropexy or bladder neck suspension surgery, urethropexy is a surgical procedure that involves repositioning the bladder to treat stress incontinence.

The goal of the procedure is to provide more support to the urethra, the tube that drains urine from the bladder and the bladder neck, the point where the bladder and urethra meet, by suturing parts of the tissues of the vagina and attaching them to the pubic bone.

Who Should Undergo and Expected Results

The surgery is performed on patients who have been diagnosed with stress incontinence, or the loss of voluntary control of the bladder due to a weak or poor support of the pelvic floor or muscles.

Stress incontinence, which normally happens among women, can be caused by medications, childbirth, and previous surgery in the pelvis, which can weaken the supporting muscles. In some cases, it can be triggered by certain activities, such as lifting heavy objects and exercising that result in added abdominal pressure.

Urethropexy isn’t often the first course of treatment for stress incontinence. Before it is even considered, doctors recommend non-surgical methods including Kegel exercises that can help strengthen the pelvic floor, biofeedback, and physical therapy. The urologist or gynaecologist may also encourage changes in behavior or lifestyle like smoking cessation, weight loss, and intake of a high-fiber diet that can prevent or reduce the triggers of stress incontinence.

The bladder neck suspension surgery becomes necessary if none of these non-surgical treatments work or if the condition is considered severe.

The procedure has a success rate of more than 80 percent, which means that in the majority of cases, the stress incontinence is completely prevented and does not recur. However, other patients may experience small amounts of leakage especially if the condition is severe.

How Does the Procedure Work?

Bladder neck suspension surgery can be performed using either open traditional technique or minimally invasive method.

Although both surgeries are done on the abdominal walls, they differ in terms of the number of incisions. In open surgery, only one long incision is needed while the surgeon makes three to four small ones in laparoscopic followed by an insertion of a laparoscope that comes with a camera so the surgeon can see the insides clearly. Either way, the bladder neck and the urethra are accessed, sutured with the vaginal tissue, and then all are connected to the pubic bone.

If more support is necessary, the surgeon may create a sling using an autologous or donated fascia or a synthetic graft material.

The surgery lasts for at least an hour while the patient is under general anaesthesia. Before the incisions are closed, a catheter may be inserted through the abdomen to help drain urine during and after the procedure. The catheter is removed within a few days or when the operated area has already healed.

Possible Risks and Complications

Some of the common risks and complications associated with bladder neck suspension surgery are bleeding, an infection that may lead to sepsis, and formation of blood clots, which can be life-threatening if they are dislodged and travel to other parts of the body like the lungs (embolism).

In some cases, the patient may develop a fistula or when the vagina is attached to its skin, and irritable bladder, which creates the urge to urinate more frequently. It’s also possible that the surgery and catheterisation can injure other organs and parts of the bladder and the urethra.

References:

  • BURCH JC. Urethrovaginal fixation to Cooper's ligament for correction of stress incontinence, cystocele, and prolapse. Am J Obstet Gynecol. 1961 Feb. 81:281-90.

  • Amaye-Obu FA, Drutz HP. Surgical management of recurrent stress urinary incontinence: A 12-year experience. Am J Obstet Gynecol. 1999 Dec. 181(6):1296-307; discussion 1307-9.

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