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What is 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.

When is it used?

The Raz procedure is most often recommended when urine leakage is caused by a loss of support in the tissues surrounding the urethra. The urethra is the tube that drains urine from the bladder to the outside. If you have other problems besides a loss of tissue support--for example problems with the bladder or the uterus--you may need a different procedure.

Your doctor may recommend surgery when attempts to strengthen these tissues with exercise or estrogen replacement have been ineffective.

What are the alternatives?

There are several alternatives:

• exercises to strengthen the muscles and other supporting tissues around the urethra
• medication, such as estrogen for women after menopause
• injections or mechanical implants
• other, more complex surgical procedures.

You should ask your doctor about these choices.

How do I prepare for a Raz procedure?

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

Follow instructions provided by your doctor. 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.

What happens during the procedure?

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.

What happens after the procedure?

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.

What are the benefits of this procedure?

Five years after the procedure, this treatment is about 75% to 80% successful in preventing urine leakage.

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.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.
• The regional anesthetic may not numb the area quite enough and you may feel some minor discomfort.
• 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 not strong enough to hold the sutures and they may come undone at some point after the surgery.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call your doctor immediately if:

• The catheter becomes plugged and you stop passing urine.
• You develop a fever.
• You have heavy bleeding from your vagina.

Call your doctor during office hours if:

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