Marshall-Marchetti-Krantz Procedure

What is a Marshall-Marchetti-Krantz procedure?

The Marshall-Marchetti-Krantz procedure is a type of surgery done to help a bladder control problem called stress incontinence. Stress incontinence is the term used for leakage of urine during exercise, coughing, sneezing, laughing, or lifting. The surgery returns the bladder and urethra to a more normal position.

When is it used?

This operation may be done if you have trouble holding urine. Your healthcare provider may recommend surgery when attempts to strengthen these tissues with exercise or other nonoperative treatments have not succeeded.

Examples of alternatives are:

• doing muscle-strengthening exercises, called Kegel exercises
• placing a pessary in the vagina (A pessary is a device that can be put into the vagina to support the vaginal walls. Your healthcare provider can help you choose an appropriate one.)
• placing a diaphragm or tampon in the vagina to support its walls
• shots of a collagen-like material through the vagina and under the bladder and urethra
• a mechanical implant to help hold urine
• other surgical procedures

You can also choose not to have treatment. You should ask your healthcare provider about these choices.

How do I prepare for a Marshall-Marchetti-Krantz procedure?

Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a general anesthetic. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

The surgeon will make a cut in your lower abdomen. He or she will separate the front of the bladder from the tissues around it and put stitches in the supporting tissue next to the bladder and urethra. (The urethra is the tube that carries urine outside the body.) The surgeon will lift the tissue around the urethra with a stitch and fasten it to the pubic bone (the bone in the front part of the pelvis) and to tissue behind the abdominal wall.

The surgeon may put a catheter (tube) into your bladder to drain urine. This tube may pass through the urethra, or the surgeon may insert it through a cut in the abdominal wall and into the bladder. Drains may be inserted through the incision to prevent infection by releasing any fluid or blood that collects in the area of the surgery. The surgeon will then close the cut.

The surgeon may put gauze in your vagina. The gauze helps the bladder and urethra stay in place while the tissue starts healing. It also helps prevent bleeding. The gauze will be removed 2 to 3 days after the surgery.

What happens after the procedure?

You may stay in the hospital 2 to 6 days, depending on how quickly you recover from the procedure. The drain will be removed a couple of days after the surgery. The catheter will stay in your bladder for 4 to 6 days or until your bladder starts working normally again.

After going home, do not lift anything heavier than 10 pounds and avoid strenuous activity for 6 to 8 weeks. Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

You should be better able to hold urine when you cough, laugh, sneeze, or exercise. Bulging and feelings of pressure in the vagina should be relieved.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• The bladder or urethra may be damaged.
• The catheter can become blocked and need to be replaced.
• You may have infection or bleeding.
• You may have trouble passing urine.
• The ureters (the tubes from the kidneys to the bladder) may be damaged.
• Stones might form in the bladder.
• You may keep having leaking of urine.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your healthcare provider right away if:

• The catheter becomes plugged and you stop passing urine.
• You have swelling and redness around the stitches closing the cut in your abdomen.
• You develop a fever over 100.5°F (38°C).
• You become dizzy and faint.
• You have bleeding.
• You have nausea and vomiting.
• You become short of breath.
• You have severe pain in the area of the surgery, your chest, or legs.

Call your healthcare provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.