Colposuspension

A colposuspension is an procedure to help women with stress urinary incontinence (leakage of urine when coughing, sneezing or moving). Sutures rather than mesh is used to lift up the neck of the bladder into a new position. Colposuspension is appropriate for women keen to avoid mesh implants, although you should remember that the sutures used in colposuspension are permanent (non-absorbable).

Some patients may be suitable to have this operation through a laparoscopic procedure (keyhole surgery) rather than open cut.

Colposuspension has been used for the treatment of stress incontinence for over 40 years so we have a lot of information about its success and how long it lasts, although most of the studies report on women who have had open rather than keyhole surgery.

In laparoscopic or open colposuspension, stitches called ‘Burch sutures’ are placed between the vaginal wall either side of the neck of the bladder and some fibrous tissue behind the pubic bone. This lifts the neck of the bladder to give it better support. Originally this operation required a bikini line cut in the tummy but it can now be done through laparoscopic (keyhole) surgery meaning a quicker recovery. After the procedure, the bladder is supported in a better position, so that the pelvic floor muscles are able to stop urine from leaking once again. The urethra is purposefully slightly kinked by the operation and this makes it harder for urine to leak out.

A cystoscopy (a camera inserted via the urethra to view the bladder) is usually performed to ensure the sutures haven’t been placed in the bladder. A drain may be left behind the pubic bone to prevent a hematoma (a collection of blood) from forming. Usually a catheter is left overnight and removed the following day.

The following complications can occur:

Overactive bladder: The bladder becomes irritable or overactive in up to 17 in 100 women. This gives symptoms of urgency (needing to rush to the toilet) or frequency (needing to pass urine more often). Sometimes an overactive bladder can make you leak because you cannot get to the toilet in time. You may need medication for this.

Prolapse: This is a bulge in the vagina caused by the vaginal walls sagging. If it happens you may feel a lump or dragging sensation. About 14 in every 100 of women who have had a colposuspension procedure are more likely to get a prolapse to the back wall of the vagina. It might be small and may not need treatment. Sometimes if prolapse is causing symptoms this can be treated with a vaginal pessary (a device inserted into the vagina) or an operation.

Difficulty passing urine: You might notice that the flow of urine is slower after the procedure. Some women notice that they have to change position on the toilet (such as leaning forward to empty the bladder completely) to get the last of the urine out. About one in ten women who have had a colposuspension has problems emptying her bladder after the procedure.

Pain during sexual intercourse: Pain during sex can happen after any operation where there are stitches near the vagina. About one in 20 women finds sex uncomfortable or painful after a colposuspension. The sensation during intercourse may be less and occasionally the orgasm may be less intense. This might improve with time.

Problems with the stitches: In a small number of women, the stitches holding the neck of the bladder in place cause problems. Over time they can wear through to the inside of the bladder. This is rare but may result in bleeding or a persistent discharge (please ask your GP for advice).

The procedure usually lasts between 60 and 90 minutes and is carried out under general anaesthetic. If performed as laparoscopic (keyhole) surgery, only one night’s stay is required. As an open procedure, a three- or four-night stay is required.

After removing the bladder catheter the day after surgery, you will be asked to measure how much urine you pass when you empty your bladder and an ultrasound scan is normally used to check that your bladder is emptying properly. If you are unable to empty your bladder fully, short-term catherisation may be required. This may get better with time, but in a small number of women it lasts forever. It is normal to leave a drop of urine in your bladder after going to the toilet. We call this the ‘residual volume’. However, if too much is left, it can lead to problems such as having to go to the toilet too often and infections of the bladder. If the residual volume is too high, you will be taught to learn how to empty your bladder using Clean Intermittent Self-Catheterisation (CISC). Most women use CISC twice a day, but the number of times it is needed will depend on each woman and how her bladder is behaving.

There will then be some discomfort at the operation site and the patient will need to take painkillers for several days. Paracetamol and/or Ibuprofen (Nurofen) are usually sufficient.

With laparoscopic surgery major incisions are avoided and recovery is quicker. Recovery usually takes four weeks. Most patients take six weeks off work. There is no need to wait for a follow-up appointment before returning to work. You should be able to be fit enough for your usual activities four to six weeks after surgery. We advise you to avoid heavy lifting and sport for six weeks to allow the wounds to heal and the bladder neck to settle into place. If the procedure is performed with open surgery, a much longer recovery is usually needed.

We usually advise you to wait for six weeks after the operation before having sex. In the long term there is no evidence that the operation will make any difference to your sex life. If you previously leaked urine during intercourse, the operation often makes this better, but unfortunately this is not always the case.

In the short term this operation is as successful as any major procedure used for controlling bladder leakage with a quicker recovery if performed laparoscopically.

In studies, between one and five years after surgery about 70% of women felt their symptoms had improved. However, there is a group of women for whom the operation does not seem to work. With time, the success of operation is reduced. The operation is less likely to be a success if you have had previous surgery to your bladder (such as a repair or a previous continence procedure) or have other bladder problems, such as an overactive bladder or difficulty emptying your bladder.