Uzm. Dr. Ertan Özen
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- 36+years exp.
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Gynaecological Surgery
Kelly plication
What Kelly plication is, how stitches under the bladder neck support the urethra, what the evidence says about stress incontinence and cystocele, how it compares with a sling and colporrhaphy, who is a good candidate, approximate costs in Turkey against the UK, US and Germany, recovery, risks and how to choose a surgeon.
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Prof. Dr. Zehra Neşe Kavak
GynaecologyVerified
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Kelly plication in Turkey: what it is and how it works
Kelly plication is a vaginal operation that supports the bladder neck and the first part of the urethra. Through a cut in the front wall of the vagina, the surgeon frees the tissue beneath the bladder neck and places stitches that fold, or plicate, the supporting layer so that it lifts and narrows the area. The aim is to stop the bladder neck dropping when you cough, sneeze or lift, which is what causes leakage in stress urinary incontinence. It is an older technique, described in the early twentieth century, and it is still used by gynaecologists and urologists, especially when the problem is mild or when a mesh or tape is not wanted.
The same name is sometimes used in cosmetic gynaecology for tightening the front vaginal wall. This guide covers the incontinence and prolapse use, explains what the evidence says, compares it with the alternatives, gives approximate costs in Turkey against the UK, US and Germany, and lists what to ask a clinic. For other pelvic and uterine procedures see our gynecology treatments in Turkey.
Who is a good candidate for Kelly plication?
The operation suits women with mild to moderate stress urinary incontinence, often together with a bladder bulge (cystocele) at the front of the vagina, who have completed their family or are not planning another vaginal birth, and who have tried pelvic floor exercises without enough benefit. It may also be chosen when someone prefers a repair that uses only their own tissue. It is less suitable for severe leakage caused by a weak urethral sphincter, for urge incontinence (sudden need to pass urine with no cough or strain), for a large prolapse of the uterus or vault, or when a previous repair has failed. A urogynaecology assessment, often with a bladder test called urodynamics, should confirm which type of leakage you have before surgery is planned.
How is Kelly plication done, step by step?
The operation is normally under spinal or general anaesthesia and takes 30 to 60 minutes, longer if it is combined with another repair. A catheter is placed in the bladder to help the surgeon locate the bladder neck. A cut is made in the front vaginal wall, the tissue is separated from the bladder and urethra, and fine absorbable stitches are placed on each side of the bladder neck and drawn together in the midline. Excess vaginal skin may be trimmed and the wall is closed. A gauze pack or catheter may stay for a day. Most hospitals keep patients overnight or for one to two nights.
Does Kelly plication stop leakage? What the evidence says
Many women notice less leakage, particularly early after surgery, but the long-term picture is less favourable than for a mid-urethral sling. Reviews of anterior vaginal repair for stress incontinence report lower long-term cure rates than for slings or retropubic suspension, because the stitched tissue can stretch again over the years. NICE guidance for urinary incontinence and the International Urogynecological Association describe mid-urethral tapes, colposuspension and bulking as the main surgical options, with plain anterior repair not recommended as the first choice for stress incontinence alone. Kelly plication is therefore best understood as an option for selected women who accept a lower likelihood of lasting control in exchange for avoiding a sling. A reasonable clinic will tell you this plainly and will not promise that you will never leak again.
Kelly plication or a sling: how do they compare?
| Option | Best suited to | Typical limits |
|---|---|---|
| Kelly plication | Mild stress leakage, often with a front-wall bulge; own tissue only | Lower long-term success; repair may stretch over time |
| Mid-urethral sling | Stress leakage, the most studied surgical option | Uses a tape; specific risks such as erosion or voiding difficulty |
| Anterior colporrhaphy | Cystocele (bladder prolapse) with or without leakage | Treats the bulge more than the leakage |
For details of the sling see our guide to the sling procedure. Some women have a Kelly plication at the same time as a repair for prolapse or a hysterectomy; see hysterectomy if a uterus problem is also being treated.
Kelly plication cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for the operation including the hospital stay, not hospital quotes. They vary with the type of anaesthesia, the length of stay and whether another repair is done at the same time.
| Country | Approximate cost range |
|---|---|
| Turkey | €1,500 – €4,500 |
| United Kingdom | €4,000 – €9,000 |
| United States | €6,000 – €16,000 |
| Germany | €3,500 – €8,500 |
A package usually covers the consultation and tests, the operation, the anaesthetist, one or two nights in hospital, medication, a follow-up check before you fly and airport transfers. Urodynamics, pelvic imaging and any added prolapse repair are often extra, so ask for the list in writing.
Your trip to Turkey and Kelly plication recovery
Plan to stay about five to seven nights so that the catheter is out, you are passing urine normally and the surgeon can examine you before the flight. Mild discomfort, spotting and a feeling of pressure are common in the first week. You walk the day after surgery and take simple painkillers. Most women return to light desk work after one to two weeks, but lifting, straining, intercourse, tampons and swimming are normally avoided for about six weeks while the repair heals. Treat constipation promptly, because straining puts stress on the stitches, and do your pelvic floor exercises once the surgeon allows. A video review after you return home lets the team check your progress.
Kelly plication before and after: what are realistic results?
There is little to see on photographs; results are judged by how often and how much you leak and by whether a bulge is gone. A realistic goal is a clear reduction in leakage and, for some women, dry days in ordinary life. Over the following years leakage can return, and a later sling or repeat operation is sometimes needed. If the operation also tightened the front wall, intercourse may feel different, and some women find it uncomfortable at first. Ask the surgeon for the likely outcome for your type of leakage, not an average, and keep a bladder diary for a week before surgery so that you can compare afterwards.
Risks and complications of Kelly plication
Common effects are temporary pain, bruising, spotting and urinary frequency. Less common risks include urinary infection, difficulty emptying the bladder, new urgency, bleeding or a collection of blood, and injury to the bladder or urethra. Pain during intercourse can follow any vaginal repair, and the leakage may come back. Anaesthetic risks and clots in the leg apply, as with any operation. The NHS and the Royal College of Obstetricians and Gynaecologists advise that you discuss all surgical choices, including non-surgical ones such as pelvic floor training, before agreeing to an operation. Report fever, heavy bleeding, severe pain or being unable to pass urine at once.
How to choose a surgeon and hospital, and red flags
Look for a gynaecologist or urologist with specific pelvic floor or urogynaecology experience who performs the operation in a licensed hospital with an anaesthetist and overnight beds. You should be offered an examination, a test of bladder function where appropriate, and an honest comparison with a sling and with exercises. Red flags are a promise to cure leakage permanently, no assessment of the type of incontinence, a fixed price offered without any information from you, cosmetic marketing, and no plan for follow-up at home. Read how our process works and send your history through the free quote page for a written plan and price.
Questions to ask the clinic:
- Do I have stress, urge or mixed incontinence, and how was that confirmed?
- Why Kelly plication instead of a sling, and what is the expected success?
- Is a mesh or tape used, and is anything else done in the same operation?
- How many nights will I stay, and what does the price include?
- Who will review me after I go home, and what happens if leakage returns?
Hospitals with Gynaecology in Turkey
Frequently asked questions
Kelly plication is a vaginal operation in which stitches fold the tissue under the bladder neck to support it. It is used for mild stress urinary incontinence, often with a front-wall bulge, and uses your own tissue rather than a tape.
It can reduce leakage, especially early on, but long-term success is lower than with a mid-urethral sling because the repair can stretch. A surgeon should explain the expected outcome for your type of incontinence.
Approximate ranges are €1,500 to €4,500 in Turkey against about €4,000 to €9,000 in the UK. The price depends on anaesthesia, hospital stay and any added repair; the hospital confirms it in a written quote.
Most women go back to light work after one to two weeks. Lifting, intercourse and swimming are usually avoided for about six weeks while the repair heals, and the surgeon will confirm when each is safe.
The operation is done under spinal or general anaesthesia. Afterwards there is soreness and pressure in the vagina for several days, normally controlled with simple painkillers.
Neither is right for everyone. A sling has stronger long-term evidence for stress leakage but uses a tape; Kelly plication uses your own tissue and has lower long-term success. Your surgeon should compare both for your case.
Risks include infection, difficulty emptying the bladder, bleeding, pain during intercourse and return of leakage. Injury to the bladder or urethra is rare. Anaesthetic and clot risks apply as with any operation.
Yes. The stitched tissue can loosen over the years, and some women need a later sling or repeat repair. Weight gain, chronic cough and constipation can add strain.
The name is sometimes used for cosmetic front-wall tightening, but the medical operation targets the bladder neck to treat leakage. Make sure your clinic states which purpose it is planned for.
About five to seven nights is usual, so the catheter is out, you pass urine normally and the surgeon can examine you before the flight. Combined operations may need a longer stay.
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