A bladder tuck is a surgical procedure that lifts and supports the bladder neck and urethra to stop stress urinary incontinence, the involuntary leaking of urine when you cough, sneeze, laugh, or exercise. Doctors call it a bladder neck suspension or colposuspension. The surgery works by stitching the tissue near the urethra to a sturdy ligament or the abdominal wall, creating a supportive hammock that keeps the bladder neck in its proper position.
Why It’s Done
Stress urinary incontinence happens when the muscles and connective tissue supporting the urethra weaken, often after pregnancy, childbirth, or menopause. When that support gives way, physical effort or sudden pressure on the abdomen can force urine out. A bladder tuck is typically considered after nonsurgical options like pelvic floor exercises and physical therapy haven’t provided enough relief.
Before recommending surgery, your doctor will confirm that your leaking fits the pattern of stress incontinence rather than another type. The American College of Obstetricians and Gynecologists outlines a minimum evaluation that includes a physical exam, a urine test, a direct demonstration of leaking during a cough or bearing down, an assessment of how much the urethra moves, and a check of how completely your bladder empties. The physical exam also rules out less common causes of leaking, such as a fistula or a small pouch forming along the urethra.
Types of Bladder Tuck Procedures
Several surgical approaches fall under the bladder tuck umbrella, but they share the same goal: lifting the junction between the bladder and urethra so it resists downward pressure more effectively. The main categories are:
- Open retropubic suspension (Burch colposuspension): The surgeon makes an incision in the lower abdomen and places stitches through the tissue alongside the urethra, then anchors those stitches to a strong ligament on the front of the pelvis called Cooper’s ligament. This is the most well-studied version and remains a standard option.
- Laparoscopic retropubic suspension: The same concept as the open Burch, but performed through small incisions using a camera and thin instruments.
- Needle suspension (Pereyra, Stamey, or Raz procedures): Sutures are passed between the vagina and the abdominal wall using a needle, avoiding a large incision. These techniques were once popular but have largely been replaced by newer options with better long-term results.
The American Urological Association currently lists three primary surgical options for stress incontinence: midurethral slings (a newer, minimally invasive approach using a small strip of material), autologous fascia slings (using a strip of your own tissue), and Burch colposuspension. All three are considered effective, and the choice depends on your anatomy, whether you’re also having surgery for pelvic organ prolapse, and your surgeon’s expertise.
How the Surgery Works
In a Burch colposuspension, the most common form of bladder tuck, the surgeon places two or three stitches on each side of the urethra, about 2 centimeters away from it. These stitches pass through the tough connective tissue layer surrounding the vaginal wall. The other end of each stitch is then attached to Cooper’s ligament on the pelvic bone.
Critically, the stitches are tied loosely, leaving a small bridge of space (roughly 2 to 4 centimeters) between the vaginal tissue and the ligament. The goal isn’t to pull the urethra tight against the bone. Instead, the loose attachment encourages scar tissue to form over time, creating a broad, natural platform of support under the urethra and bladder neck. This tension-free design is what makes the repair durable without overcorrecting the position.
Native Tissue vs. Mesh
A traditional Burch colposuspension uses only your own tissue and permanent sutures, with no synthetic mesh involved. This distinguishes it from midurethral sling procedures, which typically place a thin strip of mesh under the urethra. For patients concerned about mesh-related complications, a Burch procedure or autologous fascia sling (which uses a strip of tissue harvested from your own abdominal wall or thigh) are mesh-free alternatives.
When a sling procedure uses your own tissue, the tradeoff is a slightly longer surgery and a second incision site where the tissue is harvested. The quantity and quality of available tissue also varies from person to person. Your surgeon can help weigh these considerations based on your specific situation.
Success Rates
Bladder tuck procedures have strong track records. Open Burch colposuspension achieves success rates of 85% to 90% at one year after surgery. At the five-year mark, effectiveness settles to around 70%, meaning the majority of women remain significantly improved or fully dry years later. These numbers are comparable to midurethral sling procedures over similar timeframes.
Risks and Side Effects
No surgery is without risks, and bladder tuck procedures carry a few that are specific to how they change urinary function.
New urgency, the sudden strong need to urinate that wasn’t there before surgery, is the most common issue. It affects up to 20% of patients after incontinence surgery. For many, this settles down on its own within a few months. For others, it may need treatment with medication or pelvic floor therapy.
Voiding dysfunction, meaning difficulty emptying the bladder completely, can also occur. Some women need a temporary catheter for a few days after surgery while swelling resolves. The rate of long-term obstruction serious enough to require a second procedure is low, estimated at 1% to 2% in large surgical series.
Other general surgical risks include infection, bleeding, and injury to nearby structures like the bladder itself, though these are uncommon in experienced hands.
Recovery After Surgery
Recovery depends on whether the procedure is done through an open incision or laparoscopically. With an open Burch, you can expect a hospital stay of one to two days. Laparoscopic approaches often allow same-day or next-day discharge.
Most surgeons recommend limiting lifting to around 10 pounds for the first several weeks. This protects the healing tissue while the new support structure forms. Strenuous exercise, heavy housework, and sexual activity are typically off-limits for about six weeks. Many women return to desk jobs within two to three weeks, though physically demanding work takes longer.
You may have a catheter in place for a day or two after surgery. Before it’s removed, a test will confirm that your bladder is emptying well on its own. Some temporary burning with urination and mild pelvic discomfort are normal during the first week and gradually improve.