Marshall-Marchetti-Krantz (MMK)

What is it? Performed to correct stress incontinence in women. a common result of childbirth and/or menopause. Incontinence also occurs when an individual involuntarily loses urine after pressure is placed on the abdomen during exercise, sexual activity, sneezing, coughing, laughing, or hugging.

Anatomy Vagina Bladder Urethra Coopers Ligament Pubic Bone

Surgical Intervention Positioning Incision Patient is placed in supine – lithotomy. Draping Impervious sheet under buttocks Anticipated site outlined with towels. Transverse lap Sheet. Towel to cover vaginal access. Pfannenstiel incision is used to approach the retropubic space.

Surgical Invention Cont’d Supplies Basic pack, Double Basin Set, Gloves, #10 blades x 2, Drapes, Bovie with extention, Irrigation fluid, suction tubing, gauze sponges, laparotomy sponges, peanut sponges, suture and dressing according to surgeon. Instrumentation Major set, long set, Heaney needle holders (2). Equipment ESU, positioning aids

Operative Prep. Skin Catheter Remove anterior pubic hair Mid-chest to thighs, laterally as possible. Vulvar and Internal Vaginal prep required. Catheter Foley Catheter

Procedure (pg 809-810) Pfannenstiel incision Bladder and urethra are freed up using blunt dissection. Endopelvic fascia is incised to allow displacement of the bladder. Assistant will elevate base of bladder to facilitate suture placement/reduce tension using two gloved fingers in the vagina.

Procedure Cont’d 5. Four Heavy absorbable sutures are placed in the anterior vagina bilaterally to the urethra and are secured in the posterior symphysis or Coopers ligament. 6. All sutures are position and tied sequentially. 7. Wound drain may be placed, as well as vaginal packing. (SP) 8. Dress according to SP.

Complications Hemorrhage Infection Recurrence of Urinary Stress Incontinence ….Death