What is colposuspension?
Colposuspension is an operation to help women with stress incontinence. In Oxford we perform this through laparoscopic (keyhole) surgery.
How does it work?
Colposuspension uses stitches to lift the neck of the bladder. This means it is better supported and so helps to stop leakage when you exert yourself, cough or sneeze.
Is it suitable for all women with stress incontinence?
It is suitable for women who leak because of stress incontinence - urinary incontinence that occurs with activity such as running, laughing, sport and walking. The cause of urine leakage can usually be diagnosed by performing a urodynamic test; this is carried out on all women before a colposuspension is performed.
Colposuspension is appropriate in women with previous mesh complications related to the synthetic sling procedures. It is also appropriate for anyone keen to avoid mesh implants, although patients should remember that the sutures used in colposuspension are permanent (non-absorbable).
Colposuspension is usually not recommended for a woman who may want to have a further pregnancy, as this may cause the woman to become incontinent again.
How successful is colposuspension?
More than 80% of women are cured by a colposuspension, although the effect can wear off over time (by twenty years after the operation the cure rate drops to 60%). The satisfaction rate is lower in women who have had previous surgery for stress incontinence or who have other bladder problems, such as an overactive bladder or difficulty emptying their bladder.
How is it performed?
Colposuspension is performed under general anaesthetic through 3-4 keyhole incisions in the abdomen. Sutures are placed into the vaginal wall on either side of the bladder neck. These stitches are tied to some strong fibrous tissue just behind the pubic bone. The stitches can be absorbable or permanent, although our preference is to use permanent suture material. A telescope (cystoscope) is inserted through the urethra into the bladder to make sure that there is no bladder injury. Dissolving stitches are placed in the abdominal incisions.
What is the recovery like after surgery?
Most women spend one or two nights in the hospital after the operation. The patient goes home when the nurses are happy that she is emptying her bladder well and any discomfort is controlled. The effects of the anaesthetic will usually wear off after 24 hours. 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. Most women need six weeks off work, or eight weeks if the job is strenuous. Heavy lifting should be avoided for six weeks.
For more information about recovering from the operation, and what to expect on going home, read our information leaflet: Colposuspension for Stress Urinary Incontinence
- NHS:incontinence treatment options
- Continence Foundation
- Incontact Incontinence Advice
- Age UK: incontinence
- NICE: the management of urinary incontinence in women
- BBC - Women's Health