Name of the Procedure:

Anterior vesicourethropexy, or urethropexy (e.g., Marshall-Marchetti-Krantz, Burch); complicated (e.g., secondary repair).

Summary

Anterior vesicourethropexy, commonly referred to as urethropexy, involves surgical repositioning and stabilization of the urethra and bladder neck to address urinary incontinence. The procedure becomes complicated when it involves secondary repairs due to previous surgery or additional anatomical challenges.

Purpose

Medical Condition

The procedure addresses stress urinary incontinence, which occurs when there is unintentional urine leakage during activities that increase abdominal pressure, such as coughing, sneezing, or exercising.

Goals

• To restore proper support to the urethra and bladder neck.
• To eliminate or significantly reduce episodes of urinary incontinence.

Indications

Symptoms or Conditions

• Persistent stress urinary incontinence that hasn't responded to conservative treatments.
• Previous failed surgical interventions for urinary incontinence.

Patient Criteria

• Adequate general health to undergo surgery.
• A detailed evaluation confirming stress urinary incontinence as the primary concern.

Preparation

• Fasting: Patients are typically required to fast for at least 8 hours before the procedure.
• Medication Adjustments: Some medications, particularly blood thinners, may need to be temporarily discontinued.
• Diagnostic Tests: Urodynamic studies, cystoscopy, and pelvic imaging may be conducted to confirm the diagnosis and plan the surgery.

Procedure Description

1. Anesthesia: General or regional (spinal or epidural) anesthesia is administered.
2. Incision: A small incision is made in the lower abdomen.
3. Exposure: The bladder and urethra are exposed.
4. Suturing: Sutures are placed through the vaginal wall and adjacent tissue to lift and stabilize the urethra and bladder neck.
5. Secondary Repair: If a previous surgery was performed, scar tissue and any complications from the prior procedure are addressed.
6. Closure: The incision is closed with sutures.

Tools and Equipment

• Surgical scalpel, retractors, sutures.

Duration

The procedure typically takes 1 to 2 hours, depending on its complexity.

Setting

Performed in a hospital or a surgical center with facilities for general anesthesia.

Personnel

• Primary Surgeon: Urologist or gynecologist with expertise in pelvic floor surgery.
• Surgical Assistants: Nurses and surgical technologists.
• Anesthesiologist: Manages anesthesia and patient comfort.

Risks and Complications

Common Risks

• Infection
• Bleeding
• Pain at the surgical site

Rare Risks

• Injury to surrounding organs (e.g., bladder, intestines)
• Blood clots
• Urinary retention or difficulty urinating

Management

Complications are managed with medications, additional surgeries, or follow-up interventions as needed.

Benefits

Expected benefits include a significant reduction or complete resolution of stress urinary incontinence, often noticeable shortly after recovery.

Recovery

• Post-Procedure Care: Includes pain management, catheter care if applicable, and instructions on activity limitations.
• Recovery Time: Most patients can resume normal activities within 4 to 6 weeks, avoiding heavy lifting and strenuous exercise during this period.
• Follow-Up: Scheduled appointments to monitor healing and function.

Alternatives

Non-Surgical

• Pelvic floor muscle exercises (Kegel exercises)
• Pessaries or vaginal devices
• Medications

Surgical

• Sling procedures
• Urethral injections

Pros and Cons

Non-surgical treatments are less invasive but may be less effective for severe cases. Alternative surgical procedures can offer similar benefits but come with their own risks and recovery profiles.

Patient Experience

During the Procedure

Patients under general anesthesia will be unconscious and feel no pain; those with regional anesthesia may be awake but will not feel pain in the lower body.

After the Procedure

Post-operative discomfort managed with pain medications. Patients might experience temporary urinary catheter use and will need to follow specific care instructions to optimize healing.