What is Marshall Marchetti Krantz Procedure

Marshall Marchetti Krantz Procedure is surgery to treat uncontrolled urine loss (urinary incontinence) in women. Women with urinary incontinence often have urine loss during exercise, laughing, coughing, sneezing, and sexual intercourse.

Urinary incontinence usually affects women who have had vaginal deliveries or who have reached menopause. It occurs when the muscle and ligament tissue around the bladder and urethra become weaker, which is sometimes caused by lack of estrogen.

During this procedure, small stitches (sutures) are placed in the tissue around the bladder to help support the bladder neck.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Injury to the bladder, urethra, or surrounding organs.
• Excessive bleeding.
• Infection.
• Allergic reactions to medicines.
• Leaking of urine again or trouble urinating.
• Swelling and pain in the pelvic area (osteitis pubis).
• Increased need to urinate.
• Blood clots.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• You may have tests before the day of surgery, such as:
  • Blood tests.
  • X-ray exams.
  • Ultrasound.
  • Bladder and urine tests.
  • Cystoscopy. This is a test to look into your bladder using a small metal scope with a light.
• Ask your health care provider how your surgical site will be marked or identified.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can slow the healing process and can lead to breathing problems during and after surgery. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A thin, flexible tube (catheter) will be placed in your bladder through the urethra. It will be left in place after the procedure until you are able to urinate on your own.
• An incision will be made above the pubic bone.
• Stitches (sutures) will be placed in the tissue and ligaments around the bladder and urethra to raise (elevate) the bladder neck. The bladder neck will be sutured to the back of the pubic bone and to ligaments behind the pubic bone.
• The incision will be closed with sutures. A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have gauze or bandages (dressings) in the vagina.
• The catheter will stay in your bladder until you are urinating normally.
• You will be given antibiotic medicine and pain medicine if needed.
• Do not drive for 24 hours if you were given a sedative.

Care After Marshall Marchetti Krantz Procedure

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Some pain at the incision site. You will be given pain medicine to control it.
• Trouble urinating. You may urinate more slowly than usual.

Follow these instructions at home:

Activity

• Get plenty of rest and sleep.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not exercise or lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that it is safe.
• Do not have sexual intercourse until your health care provider says it is okay.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Safety

• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Do not drive or use heavy machinery while taking prescription pain medicine.

General instructions

• If you have a catheter, follow instructions from your health care provider about how to use it.
• Do not take baths, swim, or use a hot tub until your health care provider approves. You may take showers.
• Do not use tampons or douche until your health care provider says it is okay.
• Take over-the-counter and prescription medicines only as told by your health care provider. Do not take aspirin because it can cause bleeding.
• Resume your usual diet as told by your health care provider.
• Try to maintain a healthy weight.
• Be careful about drinking too much fluid. Talk with your health care provider about how much you can drink.
• Plan to urinate regularly.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have abnormal discharge from your vagina.
• You have a rash.
• You have light-headedness or you feel faint.
• You have pain in your abdomen.
• You have pain and burning when urinating.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.

Get help right away if:

• You have a fever.
• You have chest pain.
• You cannot urinate.
• You have shortness of breath.
• You faint.
• You have bleeding from your vagina that involves more than a small amount of blood.
• You have leg pain.
• You have swelling or pain in your pelvis.