Special Surgical Procedures II
LESSON 3: Procedures in Genitourinary Surgery
Section Iv: operations on the bladder and prostate
3-27
3-27. VISICAL-URETHRAL SUSPENSION (MARSHALL-MARCHETTI OPERATION)
a. General. This operation involves the suspension of the bladder neck to the posterior surface of the pubis in the female patient for treatment of stress incontinence.
b. Patient Preparation. The patient is usually placed in a supine position with Trendelenburg modification, but the surgeon may prefer a frogleg modification and vaginal preparation with the insertion of a Foley catheter.
c. Operative Procedure.
(1) A suprapubic incision is made to expose the prevesical space of Retzius. The bladder and urethra are separated from the posterior surface of the rectus muscles and pubis by gentle, blunt dissection.
(2) Heavy chromic sutures are placed on each side of the urethra and sewn to the periosteum and cartilage on the posterior side of the pubis.
(3) The outside of the bladder wall is then sutured with chromic gut suture to the rectus muscle to further suspend the urethra and bladder.
(4) The area is drained, and the wound is closed in layers.
