Marshall-Marchetti-Krantz Procedure

Marshall-Marchetti-Krantz (MMK) is a surgical procedure done to correct uncontrolled urine loss (urinary incontinence) in women. Urinary incontinence occurs with exercise, laughing, coughing, sneezing and sexual intercourse. Urinary incontinence is usually seen in women who have had vaginal deliveries and in menopausal women because of lack of estrogen and the weakening the muscle and ligament tissue around the bladder and the urethra.

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies to foods and medications.

  • All of the medications you are taking. This includes herbal, over-the-counter, eye drops, creams and steroids.

  • If you are using illegal drugs or drinking too much alcohol.

  • Your smoking habits.

  • Past problems with anesthetics including novocaine.

  • The possibility of being pregnant.

  • History of blood clots or bleeding problems.

  • Past surgery.

  • Other medical or health problems.

RISKS AND COMPLICATIONS

  • Injury to the bladder, urethra or surrounding organs.

  • Excessive bleeding.

  • Infection.

  • The surgery does not correct the urinary incontinence.

  • Problems with the anesthesia.

BEFORE THE PROCEDURE

Women with urinary incontinence will have a complete physical examination. This will include an examination of the bladder, X-rays, ultrasound, urodynamic testing (bladder and urinating tests), cystoscopy (looking into your bladder with a small metal scope with a light) and blood tests before scheduling the operation. Before the procedure:

  • Do not take aspirin or blood thinners a week before your surgery or as instructed by your caregiver.

  • Do not eat or drink anything 8 hours before your surgery.

  • Let your caregiver know if you develop a cold or an infection before surgery.

  • If you are being admitted the day of your surgery, arrive at the hospital at least an hour before the surgery to read and sign forms and consents.

  • Plan and arrange for help when you go home from the hospital.

  • If you smoke, do not smoke for at least two weeks before surgery.

PROCEDURE

You will be given an IV (intravenous) and medication to relax you. Then you will be put to sleep with a general anesthetic. Your lower abdomen will be shaved and washed with an antiseptic soap. A catheter is placed in your bladder through the urethra. Through an incision above the pubic bone, stitches are placed in the tissue and ligaments around the bladder and urethra to elevate the bladder neck. The bladder neck is sutured to the back of the pubic bone and ligaments behind the pubic bone.

AFTER THE PROCEDURE

You will stay in the hospital for to two to five days. If you have a vaginal packing, it will be removed in one to two days along with your intravenous. The catheter will stay in your bladder until you are urinating normally. You will be given antibiotics and pain medication if needed.

HOME CARE INSTRUCTIONS

  • Take showers instead of baths until your caregiver tells you differently.

  • Resume your usual diet.

  • Get rest and sleep.

  • Take all your medications as told by your caregiver.

  • Do not take aspirin because it can cause bleeding.

  • Do not exercise or lift over 5 pounds until your caregiver says it is okay.

  • Do not have sexual intercourse until your caregiver says it is okay.

  • Do not use tampons or douche.

  • Try to have someone at home with you for the first 2 to 3 weeks to help you with your household activities.

SEEK MEDICAL CARE IF:

  • You have abnormal vaginal discharge.

  • You have swelling and redness around the incision.

  • You develop a rash.

  • You develop medication side effects or allergies.

  • You develop lightheadedness or feel faint.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop a temperature of 100° F (37.8° C) or higher.

  • You develop vaginal bleeding. A small and light amount of blood usually occurs.

  • You develop abdominal pain.

  • You see pus coming from the incision.

  • You cannot urinate or have burning and pain when urinating.

  • You develop chest pain.

  • You develop shortness of breath.

  • You develop leg pain.

  • You pass out.