Laparoscopic Colposuspension

 

If you require the services of an interpreter, contact us on 020 3447 4735. We will do our best to meet your needs.

Contents

1. Introduction 3
2. What does laparoscopic colposuspension mean? 3
3. How can a laparoscopic colposuspension help? 4
4. What are the risks of laparoscopic colposuspension? 4
5. What will happen if I choose not to have a laparoscopic colposuspension? 13
6. What alternatives are available? 13
7. How should I prepare for a laparoscopic colposuspension? 16
8. Asking for consent 20
9. What happens during a laparoscopic colposuspension? 20
10. What should I expect after laparoscopic colposuspension? 22
11. Where can I get more information? 25
12. References 25
13. Contact details 28
14. How to find us 29

1 Introduction

Stress urinary incontinence means leakage of urine when you are coughing, sneezing, exercising or lifting. It might also happen during other activities such as walking, changing position, or even just standing up.

This leaflet provides information about an operation called a laparoscopic colposuspension. It is one of the operations that we offer to treat stress urinary incontinence. This leaflet has been made to help you understand why this operation has been recommended and what surgery might involve.

This leaflet contains information from medical research studies and guidance from independent organisations that specialise in
this type of surgery. We have tried to simplify this information and make it easy to understand for patients. We hope that this
leaflet will help you decide if you want to go ahead with surgery.

We will review this information every two years. This is to make sure that any information from new research studies is  included. We may do this sooner if we think important new information becomes available that you need to be aware of.

2 What does laparoscopic colposuspension mean?

Laparoscopic colposuspension is an operation to help with stress urinary incontinence. Using keyhole surgery, internal stitches are placed to lift up and support the base of the bladder. This helps to prevent leakage during coughing, sneezing, or activities such as exercise.

2 How can a laparoscopic colposuspension help?

If you have symptoms of stress urinary incontinence, this operation is likely to help you. Although the operation is effective, no operation will work for everybody. Some women will find that their stress urinary incontinence is not helped by the surgery. Occasionally, the operation works well initially but the problems start again some time later.

The most reliable medical research studies (called randomised trials) have shown that at five years, most women are satisfied:

  • Around 70 to 80 out of 100 women will be cured of their stress urinary incontinence or very much improved.

Other types of research have continued to monitor patients for up to 10 years after surgery. These studies suggest that the success of the procedure may drop very slightly in the long term.

Whilst this surgery is performed to help with stress urinary incontinence, it may also help with urinary urgency. Urgency means having to suddenly rush to the toilet to pass urine without warning. Most of the research would suggest that:

  • Around 60-70 out of 100 women will find that their urinary urgency improves after surgery or even disappears.

4 What are the risks of laparoscopic colposuspension?

All treatments and procedures have risks and we will talk to you about the risks of laparoscopic colposuspension. Problems that
occur during or after surgery are called complications. These are undesirable or unwanted effects that happen as a result of surgery. If a complication affects you, it does not mean that something must have gone wrong during the surgery. If you have a complication, you can expect us to explain what has happened, and whether any further treatment is required.

We always provide additional care and support for patients who experience problems after an operation.

We will use numbers to explain how often we might expect problems to happen after laparoscopic colposuspension. For
example, a ‘10 in 100’ chance of a problem means that if we performed 100 operations, the problem would happen 10 times.
This is the same as a 10 per cent chance.

Problems that may happen straight away

Bleeding during surgery

  • Bleeding that might need a blood transfusion: 1 in 100.

Infections after surgery

  • Urine infection immediately after surgery: 30 in 100.
  • Urine infections that might be a recurrent problem: 5 in 100.
  • An infection of the small ‘keyhole surgery’ wounds: 1 in 100.
  • Infection inside the pelvis: This has been reported but we do not know how often this happens. It is likely to be very uncommon.

Damage to other organs during surgery

  • Damage to bladder: 5 in 100.
  • Damage to the urethra: The urethra is the tube that you pass urine out of. Damage to the urethra has not been reported in
    research studies so it is likely to be rare. It could still happen but we are not sure what the chance of it happening is.

If you are affected, the damaged organs will be repaired during the operation. Sometimes a cut on your abdomen called a laparotomy is needed in order to fix things. If you have had previous abdominal or pelvic surgery the risk of damage may be
higher.

Rarely, damage might occur that is not recognised during the operation. If this happened, you might experience no symptoms, or you could become ill after your surgery. You would need extra tests to find out if this was the case. You might need another operation to repair the damage.

Bladder symptoms after surgery

Even if your stress urinary incontinence improves after surgery, there is small chance that you could develop other problems.
These problems might include:

  • New or worsening urinary urgency: 5-10 in 100.
  • Difficulty emptying your bladder:
    – Short term catheter use for a few days: 10 in 100.
    – Catheter use for six weeks or more: 3 in 100.
  • Being unable to pass urine at all after surgery: We are not sure how often this happens but it is likely to be rare

Pelvic pain or problems with painful sexual intercourse

If you do not have problems with pelvic pain or painful sexual intercourse before surgery, it is unlikely that you will have
problems afterwards. The risk of developing problems is low:

  • New or worsening pain in the pelvis or groins: 5 in 100.
  • New or worsening painful sexual intercourse: 1-5 in 100.
  • If you already experience chronic pain in other areas of the body, the risk of pain after surgery is higher. Sometimes, pain
    can be a long-term problem.

Problems that may happen later

Your stress urinary incontinence might come back

Whilst the operation is usually successful, it will not work in some cases. Sometimes the operation does not work right from
the start. This can occur even if the operation went well. Sometimes surgery works initially but then the leakage comes back after a few months or years. Overall, around 30 in 100 women will find that the surgery will not work long term.

You could develop a prolapse

Prolapse is a condition where the womb or vaginal walls drop down from their normal position. You may feel that ‘something
is coming down’ in the pelvis or have symptoms of a lump or bulge in the vagina. Having a laparoscopic colposuspension can sometimes make it more likely that you will develop vaginal prolapse.

The internal stitches used to lift up the base of the bladder also pull on the vaginal walls. This can weaken the tissues that support the womb and the vaginal walls, causing prolapse. Most of the time, the back wall of the vagina is affected. This is the
lower vagina covering the bowel. Occasionally, the womb can be affected. Sometimes put some extra stitches in during your
operation to try and prevent this happening. Five years after surgery, around 10-15 in 100 women might have problems with
prolapse. Sometimes this requires extra treatment that might include surgery.

Sometimes, we recommend putting in some extra stitches to try and prevent womb prolapse developing after surgery. This
makes the operation a little longer. This additional procedure is called a suture sacrohysteropexy. We have a separate information leaflet on this procedure that we will give to you. Not everyone will need a suture sacrohysteropexy. We will talk to you about this before your operation.

Problems that are rare, but serious

  • Damage to major blood vessels and life-threatening bleeding:
    1 in 1000.
  •  Blood clots in the legs that can travel to the lungs: 5 in 1000.
  •  Damage to the ureters: 5 in 1000.
  •  Damage to bowel: 1 in 100.
  • Internal stitches migrating into the bladder: 1-10 in 1000.

The ureters are the tiny tubes that carry urine from the kidneys to the bladder.

If any organs are damaged during surgery, they will be repaired whilst you are asleep. Sometimes a cut on your abdomen called
a laparotomy is needed in order to fix things. If you have had previous abdominal or pelvic surgery the risk of damage may be
higher.

Rarely, damage might occur that is not recognised during the operation. If this happened, you might experience no symptoms, or you could become ill after your surgery. You would need to extra tests to find out if this was the case and you might need another operation.

Problems with the anaesthetic

You will be given a general anaesthetic for your operation. This means that you will be unconscious and will not feel anything
during your surgery. Anaesthetists are doctors who specialise in anaesthetics. Your anaesthetist will give you your anaesthetic
medication and gently place a tube through your mouth into your throat. This is to keep your windpipe open so oxygen can get to your lungs.

Some problems are very common after an anaesthetic. They normally settle down very quickly after surgery or are easy to treat. Sore throat or throat pain, feeling sick and vomiting, or shivering after surgery, can affect up to half of patients.

Some problems are more likely to affect certain groups of patients. If you are older, overweight, a smoker, or have other medical problems, you are more likely to be affected:

  • Chest infection after surgery: 1-10 in 100.
  • Permanent nerve damage: 1 in 1000.
  • Permanent loss of sight: 1 in 100,000.
  • Death as a result of anaesthesia: 1 in 100,000.

Older patients, especially those with dementia, poor eyesight or hearing, can become confused after an operation. It is not known how often this happens.

Damage to the lips and tongue may occur but this is usually minor. Tooth damage is more likely to happen if you have diseased teeth and gums, or have had extensive dental work:

  • Damage to the lips and tongue: 5 in 100.
  • Damage to teeth: 5 in 10,000.

Some problems can happen to anyone as a result of an anaesthetic:

  • The eyeball getting grazed or damaged: 4 in 10,000.
  • Being aware of what is happening during surgery despite the anaesthetic: 5 in 100,000.
  • Life-threatening allergic reaction: 1 in 10,000.

5 What will happen if I choose not to have laparoscopic colposuspension?

If you decide not to have this operation you could simply carry on as you are. You will continue to have symptoms of stress
urinary incontinence. Whilst these symptoms can be distressing, you are unlikely to come to any harm.

6 What alternatives are available?

After reading this leaflet, you may decide that you want to look at other options. We provide a separate leaflet on the available
treatments for stress urinary incontinence and we should have given you this to read. Please ask for this leaflet if you do not already have it.

The non-surgical alternatives to laparoscopic colposuspension include:

  • Pelvic floor physiotherapy.
  • Weight loss.
  • A continence pessary.

Other surgical options include:

  • Synthetic midurethral sling.
  • Autologous sling.
  • Urethral bulking agents.
  • Artificial urinary sphincter.

Sometimes your doctor may suggest that one treatment might be better than another in your particular case. They will obviously provide you with the reasons why this is so.

7 How should I prepare for laparoscopic colposuspension?

The Preoperative Assessment Clinic (PAC)

Before your operation, you will be seen in the PAC to make sure that you are fit for your surgery. Specialist nurses and
anaesthetists run the clinic. This normally happens a few weeks before your operation. When you come to your appointment,
you should bring the following:

  • A list of your medical conditions and previous operations.
  • A list of your current medications and allergies.

Sometimes, certain types of medication need to be stopped before your operation. The team in PAC will tell you if any of
your medication needs to be stopped and which ones you should take on the day of your operation. Please do not stop any medication before your operation unless you are asked to do so. Stopping important medication before your surgery may mean that your operation is cancelled or you come to harm.

Some patients may need to take additional medication the day before their surgery to clear their bowels. This is called ‘bowel
preparation’. Not all patients require bowel preparation and if is needed, we will discuss it with you before your operation.

The day of your surgery

On the day of surgery, you will come to the Surgical Reception on the First Floor of University College Hospital at 07:00 in the
morning. You will receive a letter confirming these details. Your operating surgeons will see you for final checks. Please note
that your operating surgeon may not be the same specialist as you saw in clinic. The nurses will then prepare you for your surgery.

You may be given an enema to clear out the lower bowel before your operation. You will not need this if you took bowel preparation.

On the day of surgery, you should follow the instructions given to you at the PAC appointment about the following:

  • Which medications to take on the morning of surgery.
  • When to stop eating and drinking before your surgery.

If you are confused about any of the instructions, you must contact them before your surgery. Their details are at the end of
this leaflet.

  • Bring your regular medications along with you.
  • Pack a bag with clothes and toiletries for your stay.
  • Bring the copy of your consent form that we gave you.

Please be aware that your surgeons will be operating through the day until 19:00. They are often unable to leave the operating
theatre between patients. For this reason, they see all patients in the morning, even if surgery is planned for later in the day.

If your surgery is in the afternoon, you may be allowed to drink some water. You might also be able to leave the Surgical
Reception for a little while until you are due for surgery. Please  do not drink, or leave the Surgical Reception, until instructed to
do so. Drinking at the wrong time may mean that your operation is cancelled.

There is a very small chance that your surgery may be cancelled on the day you come in to hospital. This might happen because the hospital is full and there is no bed for you. This is uncommon but obviously very distressing if it occurs.

Whilst beds often become available as the day passes, this is not always the case. If it looks like your surgery will have to be
cancelled, we will let you know as early as we can. We will then work with our management team to rearrange your surgery as
soon as possible.

Making plans for after your surgery

  • Please make plans well in advance:
    You will be in hospital for one or two nights. Up to two people can visit you in hospital between 09:00 and 20:00 every day.
  • Please ensure that your travel plans are flexible. Remember that your stay might also be extended on medical grounds.
  • You will need an escort to help you get home and you will not be able to use public transport to get home alone.
  • You will need at least four weeks off work. If you have a strenuous job you may need slightly longer to recover.
  • You should avoid carrying anything heavier than 5kg for the first four weeks after surgery.
  • You will need friends and family to help with groceries and household chores, particularly in the first two weeks.

Unfortunately, we will be unable to extend your hospital stay if you have not made transport arrangements. If you already use
hospital transport because of a medical illness, we will be able to help arrange this. Unfortunately, hospital transport is not available for other patients.

8 Asking for your consent

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we
must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent
form. If you are unsure about any aspect of your proposed treatment, please ask to speak with a senior member of staff again. Our contact details are at the end of this leaflet.

9 What happens during a laparoscopic colposuspension?

The operation takes around two hours and is performed using ‘keyhole surgery’.

  • A camera, known as a cystoscope, is passed into the bladder through the urethra. Two thin tubes may then be passed
    through the ureters to protect them during your surgery. These tubes are called ‘ureteric catheters’.
  • Four or five small cuts are made on the abdomen and special tubes, known as ‘ports’, are placed through these cuts.
  • A tiny camera and special operating instruments are inserted through the ports.
  • Pictures of the inside of the abdomen are sent from the camera to television screens that the surgeons watch.
  • Your surgeon will place internal stitches to support the base of the bladder. These stitches are not placed into the bladder
    itself. They are inserted into strong tissue, known as fascia, which is between the front wall of the vagina and the bladder.
    Two stitches are placed in the fascia on each side.

The other ends of the stiches are pulled up and tied up to the back of the pubic bone.

  • The stitches do not dissolve and are permanent.
  • Once this part of the operation is finished, we check inside the bladder using a cystoscope inserted through the urethra. This is to make sure that none of the internal stitches passed through the bladder by accident. If all is well, we then remove
    the ureteric catheters.
  • You will have a drip in your hand and a catheter tube in the bladder.

The drip will be removed the day after surgery. The catheter might be removed whilst you are in hospital, depending how
long you stay. Sometimes we will send you home with a catheter draining into a bag on your leg for a few days. This is to let the bladder rest after surgery. If you go home with a catheter tube still in the bladder, it will need to be removed by a few days later. The urogynaecology nurses usually do this in the outpatient clinic a few days after you are sent home. You will be given an appointment for this if it is needed.

We explained earlier that laparoscopic colposuspension might make it more likely that you develop prolapse in the future. This
can happen many months or even years after the operation. If it does, the back wall of the vagina is usually affected. This is the
lower vagina covering the bowel.

Occasionally, womb prolapse can be a problem after laparoscopic colposuspension. Whilst we are operating, we can sometimes see that the womb is being pulled down by the internal stitches we are putting in. This might lead to womb prolapse in the  uture, which can cause symptoms.

If this happens, we might put in some extra internal stitches to help lift the womb up. This procedure is called a laparoscopic suture sacrohysteropexy.

This procedure does not significantly increase the risks of surgery but the operation may take a little longer. We provide an additional information leaflet on laparoscopic suture sacrohysteropexy for patients.

10 What should I expect after laparoscopic colposuspension?

The first two weeks after surgery

  • You will need to rest and take regular painkillers.
  • You should take regular medicine, known as a laxative, to keep your bowels opening every day.
  • You will spend much of your time at home but you may take short walks. You should avoid anything strenuous and lifting
    anything heavier than 5kg.
  • You should try to shower, rather than have a bath, to allow the keyhole stitches to heal. If you do take a bath, do so in
    shallow water for a maximum of ten minutes.
  • You can remove the plasters from the keyhole scars after three days and then keep the areas clean and dry.
  • You will receive a telephone clinic appointment through the post. This is normally scheduled for two to three weeks after
    surgery. The urogynaecology nurses will call you by phone on this day to check on your progress.

We will give you a two-week supply of painkillers, laxative medication, and any other drugs you will need at home. If you need further supplies after you have gone home, you will need to contact your GP.

Weeks two to four after surgery

  • You will be able to reduce your regular painkillers, start taking them only if needed, and eventually stop using them.
  • You will continue to use your laxatives to keep your bowels opening daily. If you can do this by eating plenty of fruit and
    fibre, and drinking enough water, you can stop the laxatives.
  • You can increase your activity, go out for longer walks, and visit friends and family, provided you take things easy.
  • You will continue to avoid lifting anything heavier than 5kg.
  • You can start driving again but you should inform your insurance company that you have had surgery. They must be happy for you to drive again. You should only start driving again if you feel safe to do so. You must be able to perform an emergency stop if needed.

Four weeks onwards

  • You can get back into your normal routine and return to work. If you have a strenuous job, you may need slightly longer to
    recover. Please let us know if this is the case.
  • If you exercised regularly before your surgery, please discuss this with us before you go home. We might suggest some
    changes to your usual exercise programme.
  • You can start having sexual intercourse after six weeks.

We will send you a clinic appointment through the post for three months after your surgery. At the appointment, we will ask you
how things are and examine you. This is to make sure that the operation has worked and that you do not have any problems.

 

11 Where can I get more information?

The British Society of Urogynaecology
Website: www.bsug.org.uk/patient-information.php
Email: bsug@rcog.org.uk
Telephone: 020 7772 6211
Fax: 020 7772 6410

The International Urogynecological Association
Website:
http://www.iuga.org/general/custom.asp?page=patientinfo
Email at: www.iuga.org/general/?type=CONTACT

UCLH cannot accept responsibility for information provided by
other organisations.

12 References

Aarts, J. W., T. E. Nieboer, N. Johnson, E. Tavender, R. Garry,
B. W. Mol and K. B. Kluivers (2015). “Surgical approach to
hysterectomy for benign gynaecological disease.” Cochrane
Database Syst Rev(8): CD003677.

Albo, M. E., H. E. Richter, L. Brubaker, P. Norton, S. R. Kraus,
P. E. Zimmern, T. C. Chai, H. Zyczynski, A. C. Diokno, S.
Tennstedt, C. Nager, L. K. Lloyd, M. FitzGerald, G. E. Lemack,
H. W. Johnson, W. Leng, V. Mallett, A. M. Stoddard, S.
Menefee, R. E. Varner, K. Kenton, P. Moalli, L. Sirls, K. J.
Dandreo, J. W. Kusek, L. M. Nyberg, W. Steers and N. Urinary
Incontinence Treatment (2007). “Burch colposuspension versus
fascial sling to reduce urinary stress incontinence.” N Engl J
Med 356(21): 2143-2155.

Barr, S., F. M. Reid, C. E. North, G. Hosker and A. R. Smith
(2009). “The long-term outcome of laparoscopic
colposuspension: a 10-year cohort study.” Int Urogynecol J
Pelvic Floor Dysfunct 20(4): 443-445.

Dean, N. M., G. Ellis, P. D. Wilson and G. P. Herbison (2006).
“Laparoscopic colposuspension for urinary incontinence in
women.” Cochrane Database Syst Rev(3): CD002239.

Demirci, F., O. Yucel, S. Eren, A. Alkan, E. Demirci and U.
Yildirim (2001). “Long-term results of Burch colposuspension.”
Gynecol Obstet Invest 51(4): 243-247.

Desciak, M. C. and D. E. Martin (2011). “Perioperative
pulmonary embolism: diagnosis and anesthetic management.” J
Clin Anesth 23(2): 153-165.

Eriksen, B. C., B. Hagen, S. H. Eik-Nes, K. Molne, O. K.
Mjolnerod and I. Romslo (1990). “Long-term effectiveness of the
Burch colposuspension in female urinary stress incontinence.”
Acta Obstet Gynecol Scand 69(1): 45-50.

Galloway, N. T., N. Davies and T. P. Stephenson (1987). “The
complications of colposuspension.” Br J Urol 60(2): 122-124.

Harkki-Siren, P., J. Sjoberg and T. Kurki (1999). “Major
complications of laparoscopy: a follow-up Finnish study.” Obstet
Gynecol 94(1): 94-98.

Jimenez, D., J. de Miguel-Diez, R. Guijarro, J. Trujillo-Santos,
R. Otero, R. Barba, A. Muriel, G. Meyer, R. D. Yusen, M.
Monreal and R. Investigators (2016). “Trends in the
Management and Outcomes of Acute Pulmonary Embolism:
Analysis From the RIETE Registry.” J Am Coll Cardiol 67(2):
162-170.

Karram, M. M. and N. N. Bhatia (1989). “Management of
coexistent stress and urge urinary incontinence.” Obstet
Gynecol 73(1): 4-7.

Koonings, P., A. Bergman and C. A. Ballard (1988). “Combined
detrusor instability and stress urinary incontinence: where is the
primary pathology?” Gynecol Obstet Invest 26(3): 250-256.

Lapitan, M. C. and J. D. Cody (2016). “Open retropubic
colposuspension for urinary incontinence in women.” Cochrane
Database Syst Rev 2: CD002912.

Novara, G., W. Artibani, M. D. Barber, C. R. Chapple, E.
Costantini, V. Ficarra, P. Hilton, C. G. Nilsson and D. Waltregny
(2010). “Updated systematic review and meta-analysis of the
comparative data on colposuspensions, pubovaginal slings, and
midurethral tapes in the surgical treatment of female stress
urinary incontinence.” Eur Urol 58(2): 218-238.

Royal College of Anaesthetists (2015). Information leaflets.
[online] Available at: http://www.rcoa.ac.uk/node/3324.

Scotti, R. J., G. Angell, R. Flora and W. M. Greston (1998).
“Antecedent history as a predictor of surgical cure of urgency
symptoms in mixed incontinence.” Obstet Gynecol 91(1): 51-54.

Wang, A. C. (1996). “Burch colposuspension vs. Stamey
bladder neck suspension. A comparison of complications with
special emphasis on detrusor instability and voiding
dysfunction.” J Reprod Med 41(7): 529-533.

Ward, K. L., P. Hilton, Uk and T. V. T. T. G. Ireland (2008).
“Tension-free vaginal tape versus colposuspension for primary
urodynamic stress incontinence: 5-year follow up.” BJOG
115(2): 226-233.

13 Contact details

Urogynaecology nursing team
(For medical problems and questions only)
Direct line: 020 3447 6547
Mobile: 07951 674140
Fax: 020 3447 6590
Email: urogynaecology@uclh.nhs.uk

Gynaecology outpatient appointments
(Contact for outpatient clinic appointments only)
Direct line: 020 3447 9411
Fax: 020 3447 6590

Preoperative Assessment Clinic (PAC)
(Contact for questions about PAC only)
Direct line: 020 3447 3167
Fax: 020 3383 3415

Gynaecology Admissions
(Contact for surgery dates and scheduling only)
Direct line: 020 3447 2504

Urogynaecology secretary
Direct line: 020 3447 2516
Fax: 020 3447 9775

University College Hospital
Switchboard: 020 3456 7890
Website: www.uclh.nhs.uk

14 How to find us

The Urogynaecology and Pelvic Floor Unit
Clinic 2, Lower Ground Floor
Elizabeth Garrett Anderson (EGA) Wing
University College Hospital
25 Grafton Way
London
WC1E 6DB