Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Marshall-Marchetti Operation


Related Terms

  • Bladder Neck Suspension
  • Marshall-Marchetti-Krantz Procedure
  • Vesicourethropexy

Specialists

  • Gynecologist
  • Urologist

Comorbid Conditions

Factors Influencing Duration

Factors that influence the length of disability include any postsurgery complications such as infection, hemorrhage, urinary retention, chronic inflammation, and pain of the pubic bone area (pubic symphysis).

Medical Codes

ICD-9-CM:
59.5 - Retropubic Urethral Suspension; Burch Procedure; Marshall-Marchetti-Krantz Operation; Suture of Periurethral Tissue to Symphysis Pubis; Urethra Suspension NOS

Overview

The Marshall-Marchetti operation is performed to relieve stress urinary incontinence in women. There are many terms for this type of procedure, including bladder neck suspension and vesicourethropexy (vesico means bladder, and urethropexy means surgical fixation of the urethra).

In this surgical procedure, the lower part of the bladder that connects to the urethra and bladder neck is raised and repositioned higher in the pelvis. As a result, the muscles of the pelvic floor can squeeze more effectively, thus helping the individual have more control over urination and less leakage from the bladder. Sutures applied between the bladder and nearby structures or tissues hold the bladder in a more functional position.

Multiple procedures similar to the Marshall-Marchetti procedure, including the Burch procedure, have been developed to control female stress incontinence. In fact, the surgical procedures used for stress urinary incontinence (SUI) are in a state of flux. The Marshall-Marchetti procedure is infrequently used at this time, and has been replaced by laparoscopic and transvaginal procedures, which frequently use tissue to support the urethra and bladder neck.

Source: Medical Disability Advisor



Reason for Procedure

This procedure is performed to treat a type of urinary incontinence called "stress incontinence," which refers to the inability to control urine when pressure from the abdomen places extra pressure on the bladder. It is caused by the weakening of tissues that support the urethra and bladder, allowing the bladder neck and urethra to shift into an abnormal position in the pelvis. When the bladder neck and urethra are positioned abnormally, the muscles surrounding the urethra cannot prevent urine leakage when extra pressure is simultaneously placed on the bladder. Abdominal pressure increases pressure on the bladder during normal activities such as sneezing, coughing, laughing, physical activity, and even sometimes by simply changing position resulting in urinary incontinence.

In women, the tissues and muscles that support the bladder and urethra most often become weakened by pregnancy and vaginal delivery; they may also weaken following menopause when the beneficial effects of estrogen are no longer present.

Source: Medical Disability Advisor



How Procedure is Performed

The procedure is performed through an incision in the abdomen (an open procedure). An incision is made low across the abdomen (suprapubic). The surgeon opens up the area around the bladder and urethra, separates the bladder and urethra from surrounding structures, lifts the vagina upward, and places sutures through tissue in the wall of the vagina along side the urethra, suturing the tissue to the pubic symphysis (symphysis pubis) to provide support for the urethra. The skin is closed, and a dressing is applied. A temporary packing may be placed in the vagina. Urine is drained by a catheter placed in the bladder during surgery. The catheter that is placed in the bladder may be inserted either through the urethra (Foley catheter), or it may be inserted into the bladder through a tiny incision made through the abdominal wall (suprapubic catheter).

The procedure may also be performed laparoscopically. The laparoscope is a lighted tube used for viewing the inside of the abdomen and pelvis. Instead of being performed through an incision in the abdomen, the procedure is performed through the laparoscope. Three or four small puncture wounds are placed in the abdomen, and all instruments needed for the procedure are inserted through the puncture wounds.

Source: Medical Disability Advisor



Prognosis

Approximately 85% of women who undergo surgery are cured of their stress incontinence (Smith). These women are able to urinate (void) normally and are not affected by stress incontinence. The best chance of a favorable outcome occurs after the first surgery to relieve stress incontinence. Also, abdominal procedures in which the bladder neck is stabilized provide the best chance of a good outcome. Vaginal procedures may continue to allow bladder neck movement, which may result in continued incontinence. Finally, the outcome is poorer in women who have very low pressure in the urethra (found with urodynamic testing) prior to surgery.

Source: Medical Disability Advisor



Complications

Complications include injury to or perforation of the bladder, urethra, bowel, or rectum. Hemorrhage may also occur. The individual may develop wound infection at the site of the incision. During the procedure, complications from anesthesia can occur. Some individuals may experience chronic inflammation and pain of the pubic bone (pubic symphysis). Another complication is incomplete emptying of the bladder during urination, resulting in the accumulation of urine in the bladder (urinary retention). Urinary retention may lead to another type of incontinence known as overflow incontinence. In some cases, stress incontinence continues to occur.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Recovery is somewhat longer for open abdominal surgery than through laparoscopic surgery. The individual may gradually return to normal activities, but heavy lifting and strenuous exercise are prohibited for 1 to 3 weeks after surgery, with a gradual increase thereafter. Normal activities may be resumed in about 6 weeks. Development of complications such as infection may increase recovery time. Some individuals go home with a catheter remaining in the bladder and attached to a leg bag. A longer recovery period may be needed for these individuals, or if the individual returns to work with a catheter, work restrictions and accommodations may be needed to provide care to the catheter.

Source: Medical Disability Advisor



References

Cited

Smith, Joseph F. "Marshall-Marchetti-Krantz Procedure." CHC Medical Library & Patient Education. Dr. Joseph F. Smith Medical Library. 3 Jan. 2005 <http://www.chclibrary.org>.

Source: Medical Disability Advisor






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