Name of the Procedure:

Anterior Vesicourethropexy (Urethropexy): This can also be commonly referred to as Marshall-Marchetti-Krantz or Burch colposuspension.

Summary

Anterior vesicourethropexy is a surgical procedure aimed at lifting and securing the bladder and urethra to pelvic structures. This helps to restore normal anatomy and improve bladder control in patients experiencing stress urinary incontinence.

Purpose

The procedure addresses stress urinary incontinence, a condition where there is involuntary leakage of urine during physical activity, coughing, sneezing, or lifting. The goal is to prevent urine leakage by providing additional support to the urethra and bladder neck.

Indications

The procedure is indicated for patients:

• Experiencing stress urinary incontinence that has not responded to non-surgical treatments.
• With pelvic organ prolapse contributing to incontinence.
• In good general health and fit for surgery.

Preparation

Before the procedure, patients may need to:

• Undergo a full medical evaluation, including a physical exam and urodynamic testing.
• Adjust or cease certain medications as advised by the physician.
• Observe fasting instructions, typically nothing to eat or drink after midnight before the surgery.
• Arrange for post-procedure transport and support at home.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A small incision is made in the lower abdomen.
3. Exposure: The bladder and urethra are exposed.
4. Sutures: Sutures are placed on either side of the bladder neck and anchored to a pelvic ligament or the pubic bone.
5. Securing: The urethra and bladder neck are lifted and secured in place.
6. Closure: The incision is closed using sutures or staples.

Tools and Equipment: Surgical sutures, retractors, and other standard surgical instruments are used.

Duration

The procedure typically lasts about 1 to 2 hours.

Setting

It is usually performed in a hospital operating room.

Personnel

• Surgeon: A specialist in urology or gynecology.
• Nurses: Operating room and recovery room nurses.
• Anesthesiologist: To manage pain and sedation.

Risks and Complications

• Common risks include bleeding, infection, and pain.
• Rare risks may involve injury to surrounding organs, urinary retention, or recurrence of incontinence.
• Postoperative management of complications involves antibiotics for infection and sometimes additional surgery for severe complications.

Benefits

• Reduction or elimination of stress urinary incontinence.
• Improved quality of life.
• Benefits are typically realized within a few weeks after recovery.

Recovery

• Patients may need to stay in the hospital for 1-2 days post-surgery.
• Instructions include avoiding strenuous activity and lifting for 6 weeks.
• Follow-up appointments ensure proper healing and function.
• Full recovery usually takes about 6 weeks.

Alternatives

• Pelvic Floor Exercises: Non-surgical option but may be less effective for severe cases.
• Medication: May help to manage symptoms but not a long-term solution.
• Other Surgical Procedures: Sling procedures and minimally invasive options.

Patient Experience

• During: Under anesthesia, patients will not feel the surgery.
• After: Mild to moderate pain controlled with medication.
• Possible temporary urinary catheter placement.
• Patients might experience some initial discomfort and restricted activities during recovery.

Pain management measures, along with comprehensive post-operative care, ensure a smooth recovery and return to normal activities.