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Bladder suspension

Bladder suspension is a procedure to help put a sagging bladder back into its normal position.

This operation is also known as bladder neck suspension, and may be recommended to treat stress incontinence.

Who needs bladder suspension surgery?

Your GP or urologist may recommend bladder suspension surgery if you have moderate to severe stress incontinence that does not get better with non-invasive treatments such as pelvic floor exercises, medication and electrical stimulation.

For example, bladder suspension surgery may be an option if you develop stress incontinence because of:

  • Childbirth
  • The menopause
  • Problems with the muscles in the bladder and urethra (the tube that carries urine from the body)
  • Surgery

Most often, surgeons perform this type of operation on women. However, the procedure may also be done in men who develop stress incontinence after having all or part of their prostate gland removed.

Before considering bladder suspension surgery it’s important to confirm symptoms are actually brought on by stress incontinence. If need be, seek a second opinion. Bladder suspension surgery only helps treat stress incontinence. It is not helpful for other forms of incontinence. The top reason surgery fails is an incorrect diagnosis.

Types of bladder suspension surgery

There are different ways to place the bladder back to its normal position. Bladder suspension surgical techniques include:

  • Open retropubic suspension surgery
  • Laparoscopic retropubic suspension surgery
  • Needle bladder neck suspension surgery

Open colposuspension surgery involves pulling up the bladder neck and sewing it to the surrounding bone or tissue with sutures. It is a form of abdominal surgery. The surgeon makes an incision in the abdominal area a few inches below the belly button and locates the bladder and urethra, the tube through which urine flows out of the body. The procedure improves symptoms of stress incontinence that result from sagging of the bladder neck or urethra. Open colposuspension surgery is also called retropubic suspension surgery.

Laparoscopic colposuspension (retropubic) surgery has been around since the early 1990s. It uses a smaller incision than the open procedure to lift the up the bladder. 

Sling surgery uses a piece of body tissue, called fascia, or man-made material to create a sling or hammock-like structure that cradles the sagging bladder neck. This supports the bladder neck and urethra. You can use your own tissue for the procedure (if so, it is removed from your abdominal wall) or donated tissue.

You and your surgeon will discuss which procedure is best for you. Your surgeon will consider the following factors when choosing your procedure: other health conditions you may have, the anatomy of your urinary tract and surrounding structures, and the surgeon's experience.

Complications

All operations have risks. The most common complication after any type of colposuspension operation is trouble urinating. Fewer than 5% of patients have permanent urinary retention. This may require urinary catheterisation from time to time.

Other complications associated with colposuspension surgery are rare but may include:

  • Abscess
  • Bladder spasms
  • Bleeding
  • Blood clots
  • Injury to the bladder, urethra and other urinary tract structures
  • Infection (catheter-related infections are the most common)
  • Overactive bladder
  • Reactions to anaesthesia
  • Vaginal prolapse

Complications associated with sling surgery may include:

  • Injury to the bladder, urethra and other urinary tract structures
  • Infection (catheter-related infections are the most common)
  • Man-made sling material may wear away, leading to infection or reduced effectiveness
  • Reactions to anaesthesia
  • Overactive bladder
  • Trouble urinating after the procedure
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