What is open retropubic suspension?

Open Retropubic Suspension
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Open retropubic suspension surgery: Overview

Retropubic suspension treats stress urinary incontinence in women. The surgery lifts the sagging bladder and urethra. Then it supports them in their normal positions in the pelvis. The urethra is the tube that carries urine from the bladder to outside the body.

In open surgery, a doctor makes a cut in your lower belly. This cut is called an incision. The doctor will attach the bladder and the urethra to the pubic bone or other tissues. The stitches lift and hold the bladder and urethra in their normal positions. Then the doctor will close the incision with stitches.

You'll have a scar that's about 5 inches long. The scar will fade with time.

Most women go home 2 or 3 days after the surgery. You may be able to go back to most of your usual activities in 2 to 4 weeks. But you may need 4 to 6 weeks to fully recover.

How can you care for yourself after open retropubic suspension surgery?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
  • Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for 4 to 6 weeks or until your doctor says it is okay.
  • For 4 to 6 weeks or until your doctor says it is okay, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
  • Ask your doctor when you can drive again.
  • You will probably need to take 2 to 4 weeks off from work. It depends on the type of work you do and how you feel.
  • You may shower as usual. Pat the cut (incision) dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.
  • Ask your doctor when it is okay for you to have sex.

Diet

  • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
  • Drink plenty of fluids (unless your doctor tells you not to).
  • You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
  • If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

  • If you have strips of tape on your incision, leave the tape on for a week or until it falls off.
  • Wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
  • Keep the area clean and dry.

Exercise

  • Ask your doctor when you can do pelvic floor (Kegel) exercises, which tighten and strengthen pelvic muscles. Your doctor may want you to wait several weeks after surgery before you do them.
  • To do Kegel exercises:
    • Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
    • Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
    • Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
    • Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.
  • If doing these exercises causes pain, stop doing them and talk with your doctor.

How do you prepare for open retropubic suspension surgery?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

  • You may need to empty your bowels with an enema or laxative. Your doctor will tell you how to do this.
  • Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
  • Understand exactly what surgery is planned, along with the risks, benefits, and other options.
  • If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
  • Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
  • Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

After open retropubic suspension surgery: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have severe trouble breathing.
  • You have sudden chest pain and shortness of breath, or you cough up blood.
  • You have severe pain in your belly.

Call your doctor now or seek immediate medical care if:

  • You have bright red vaginal bleeding that soaks one or more pads in an hour, or you have large clots.
  • You are sick to your stomach or cannot keep fluids down.
  • You have pain that does not get better after you take pain medicine.
  • You have loose stitches, or your incision comes open.
  • Your incision is bleeding.
  • You have vaginal discharge that has increased in amount or smells bad.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the incision.
    • Pus draining from the incision.
    • A fever.
  • You have clots of blood in your urine.
  • You have trouble passing urine or stool, especially if you have pain or swelling in your lower belly.
  • You have new or worse pain when you urinate.
  • You have pain in your back just below your rib cage. This is called flank pain.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You do not have a bowel movement after taking a laxative.

After open retropubic suspension surgery: Overview

Retropubic suspension is surgery to treat stress urinary incontinence in women. The surgery lifts the sagging bladder and urethra and supports them in their normal positions in the pelvis. The urethra is the tube that carries urine from the bladder to outside the body. After surgery, you may feel weak and tired for several days. You will probably feel some pain or cramping in your lower belly and need pain medicine for a week or two. You may feel like you need to urinate more often, and your urine may be pink. This usually gets better 1 to 2 weeks after surgery.

You will have a tube (catheter) in place to drain urine from your bladder.

You should have less or no urine leakage when you sneeze, cough, laugh, or exercise. In fact, at first you may find that it's harder than usual to empty your bladder. This usually gets better 1 to 2 weeks after the catheter is removed.

You will probably be able to go back to work and most of your usual activities in 2 to 4 weeks. But you may need 4 to 6 weeks to fully recover. Try to avoid heavy lifting and strenuous activities that might put extra pressure on your bladder while you recover.

What happens on the day of your open retropubic suspension surgery?

  • Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
  • Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Do not shave the surgical site yourself.
  • Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

  • Bring a picture ID.
  • The area for surgery is often marked to make sure there are no errors.
  • You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
  • The surgery will take about 1 hour.

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