The Raz Procedure

The Raz procedure is named for the surgeon who developed it, Dr. Shlomo Raz. It is a type of surgery done to help a bladder control problem called stress incontinence. Stress incontinence is the term used for leakage of urine during exercise, coughing, sneezing, laughing, or lifting.

This operation may be performed if you have trouble holding urine. Your health care provider may recommend surgery when attempts to strengthen these tissues with exercise or other nonoperative treatments have not succeeded.

Examples of alternatives are:

• exercises to strengthen the muscles and other supporting tissues around the urethra
• use of a vaginal pessary, a device inserted into the vagina (birth canal) to help support the vaginal walls and pelvic organs
• injections of a collagenlike material through the vagina and under the bladder and urethra
• a mechanical implant to help hold urine
• other, more complex surgical procedures.

You can also choose not to have treatment. You should ask your health care provider about these choices.

Plan for your care and recovery after the operation. Find someone to drive you home after the surgery. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your health care provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your wounds will heal much better if you do not smoke after the surgery.

Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

You are given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. A general anesthetic relaxes your muscles, makes you feel as if you are in a deep sleep, and prevents you from feeling pain.

The surgeon places a small lighted tube (cystoscope) in the urethra and bladder during the procedure to help him or her see your organs and to prevent sutures from being placed through the urethra. Your surgeon makes a small incision in the skin of your abdomen just above the pubic bone. Another small incision is made inside the vagina. In between these two cuts a strong suture (stitch) is placed encircling the urethra and much of the supporting tissues. The small vaginal and abdominal incisions are then closed.

A catheter (drainage tube) may be placed into your bladder through the skin over it so the urine will drain through the catheter and not through the urethra while you heal.

You may stay in the hospital about 1 to 2 days. The catheter may stay in your bladder for 1 to 2 weeks after surgery.

After going home, do not lift anything heavier than 10 pounds and avoid strenuous activity for 8 to 10 weeks. Ask your health care provider what other steps you should take and when you should go back for a checkup.

You should be better able to hold urine when you cough, laugh, sneeze, or exercise.

One of the advantages of the Raz procedure over other surgical treatments is that it involves less surgical manipulation of the bladder, other female organs, and the abdominal cavity. For this reason it is less likely to cause serious complications.

• There are some risks when you have general anesthesia. Discuss these risks with your health care provider.
• The regional anesthetic may not numb the area quite enough and you may feel some minor discomfort.
• The bladder or urethra may be damaged.
• You may develop an infection or bleeding.
• You may have trouble passing urine.
• You may have discomfort in the area of the stitches or discomfort in the vagina (for example, when you have intercourse).
• The tissues may not be strong enough to hold the sutures and they may come undone sometime after the surgery. You would then have trouble holding your urine again.

You should ask your health care provider how these risks apply to you.

Call your health care provider right away if:

• The catheter becomes plugged and you stop passing urine.
• You develop swelling and redness around the stitches closing the cut in your abdomen.
• You develop a fever over 100°F (37.8°C).
• You have heavy bleeding from your vagina.
• You have severe pain.

Call your health care provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.