UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

BLADDER NECK SUSPENSION

Ceren Sağlam

İzmir City Hospital, Department of Gynecology and Obstetrics, İzmir, Türkiye

Sağlam C. Bladder Neck Suspension. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.191-196.

ABSTRACT

Bladder neck suspension surgery constitutes one of the cornerstone treatment modalities for female stress urinary incontinence (SUI), particularly in women with urethral hypermobility and preserved intrinsic sphincter function. The primary objective of these procedures is to re-establish anatomical stability of the bladder neck and proximal urethra, enabling appropriate urethral compression during episodes of increased intra-abdominal pressure and thereby preventing urinary leakage. Historically, the Marshall-Marchetti-Krantz (MMK) procedure, introduced in the mid-20th century, represented the most widely performed technique. This method provides support by anchoring the bladder neck to the periosteum of the symphysis pubis, yet it is associated with complications such as osteitis pubis and long-term voiding dysfunction. As an alternative, the Burch colposuspension was developed, in which paravaginal tissues are fixed to Cooper’s ligament, offering lower bone-related morbidity while maintaining comparable continence outcomes.

The introduction of minimally invasive approaches during the 1990s marked a significant advance in surgical management of SUI. Laparoscopic bladder neck suspension, performed either via transperitoneal or extraperitoneal access, follows the principles of Burch colposuspension but benefits from smaller incisions, reduced blood loss, shorter hospital stay, and more rapid postoperative recovery. Reported shortand mid-term cure rates of laparoscopic procedures are comparable to those of open techniques, with studies indicating success rates of 80–90% in selected patients. However, the efficacy of these operations is highly dependent on careful patient selection and the surgeon’s proficiency in laparoscopic pelvic anatomy.

Despite favorable outcomes, complications remain a clinical concern. Intraoperative risks include bladder and urethral injuries, bleeding, and damage to adjacent organs. Early postoperative problems may involve urinary retention, hematoma, or infection, while long-term complications include voiding dysfunction, recurrent SUI, de novo urgency, and pelvic organ prolapse. Success rates, although initially high, tend to decline over time, with MMK and Burch procedures demonstrating continence rates of approximately 70–75% at 10–15 years.

Future perspectives focus on enhancing outcomes and minimizing complications through the use of advanced biomaterials, improved suture techniques, robotic-assisted platforms, and patient-tailored surgical strategies. In this context, bladder neck suspension procedures are expected to remain integral in the treatment of SUI, especially in carefully selected patient groups, emphasizing the importance of individualized management and long-term follow-up.

Keywords: Urinary incontinence, stress; Laparoscopy; Urinary bladder; Minimally invasive surgical procedures; Urethra

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