1. Marshall-Marchetti-Krantz (MMK)

2. 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.

3. Anatomy
Vagina
Bladder
Urethra
Coopers Ligament
Pubic Bone

4. 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.

5. 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

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

7. 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.

8. 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.

9. Complications Hemorrhage Infection
Recurrence of Urinary Stress Incontinence
….Death