Laparoscopic Colposuspension

Stress incontinence (SI) is leakage that occurs with cough, sneeze or strain. It results from weakness of the valve mechanism, usually secondary to childbirth and aging.

All patients should have attempted pelvic floor exercises prior to surgery.

Colposuspension re-supports the bladder neck, using the front wall of the vagina to create a hammock. The vaginal vault is lifted towards, and secured to, the pubic bone using laterally placed sutures. This remains the most established and reliable anti-incontinence operation for typical SI, with initial success rates of 85%, maintained to 70% at 10 years.

The procedure is performed abdominally (or from above). There is a choice between an open or laparoscopic approach. Laparoscopy is associated with less pain, less blood loss and superior recovery when compared to the open procedure, and allows an earlier return to normal function. The scars are small and cosmetically superior. It follows the same principles as open surgery and achieves similar early results in terms of cure of the underlying condition. However, there is some suggestion that the long-term success may be less than with the open approach.

The technique is more difficult and more expensive, with longer operating times. The procedure is performed under general anaesthetic. Recovery is quick, up and about on the first day, with a hospital stay in the majority of patients of 2 days.

Pre-operatively:

• discontinue aspirin 1 week prior, other medications may need to be stopped
• enema the night prior and nil by mouth from midnight

Post-operatively:

• 1st post-operative day: mobilisation and diet, reinstate usual medications, catheter and vaginal pack removed
• activity as tolerated but avoid heavy lifting or straining for 6 weeks
• resume sexual intercourse at 6 weeks

Whilst the outcomes of colposuspension are excellent, recurrent incontinence and voiding difficulties occur in up to 15% of patients. All patients report slower voiding and some describe altered sensation of voiding and desire to void.

Urine retention, needing to self-catheterise intermittently is uncommon (1%) in patients with normal voiding pre-operatively.

New irritative urinary symptoms of frequency-urgency-nocturia and vaginal prolapse each occur in some 5% of patients.

Other surgical complications occur overall in 5-10% of patients. Those recognised as common or serious are listed below but this does not include the rare and extraordinary. We try at all costs to avoid any adverse outcome.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.