Efficacy and perioperative safety of synthetic mid-urethral slings in obese women with stress urinary incontinence

Obesity as an independent risk factor for poor long-term outcome after mid-urethral sling surgery

INTRODUCTION

High body mass index (BMI) is a risk-factor for stress urinary incontinence (SUI). Mid-urethral sling (MUS) surgery is an effective treatment of SUI. The aim of this study was to investigate if there is an association between BMI at time of MUS-surgery and the long-term outcome at 10 years.

MATERIAL AND METHODS

Women who went through MUS surgery in Sweden between 2006 and 2010 and had been registered in the Swedish National Quality Register of Gynecological Surgery were invited to participate in the 10-year follow-up. A questionnaire was sent out asking if they were currently suffering from SUI or not and their rated satisfaction, as well as current BMI. SUI at 10 years was correlated to BMI at the time of surgery. SUI at 1 year was assessed by the postoperative questionnaire sent out by the registry. The primary aim of the study was to investigate if there is an association between BMI at surgery and the long-term outcome, subjective SUI at 10 years after MUS surgery. Our secondary aims were to assess whether BMI at surgery is associated with subjective SUI at 1-year follow-up and satisfaction at 10-year follow-up.

RESULTS

The subjective cure rate after 10 years was reported by 2108 out of 2157 women. Higher BMI at the time of surgery turned out to be a risk factor for SUI at long-term follow-up. Women with BMI <25 reported subjective SUI in 30%, those with BMI 25-<30 in 40%, those with BMI 30-<35 in 47% and those with BMI ≥35 in 59% (p < 0.001). Furthermore, subjective SUI at 1 year was reported higher by women with BMI ≥30, than among women with BMI <30 (33% vs. 20%, p < 0.001). Satisfaction at 10-year follow-up was 82% among women with BMI <30 vs 63% if BMI ≥30 (p < 0.001).

CONCLUSIONS

We found that higher BMI at the time of MUS surgery is a risk factor for short- and long-term failure compared to normal BMI.

Pelvic floor dysfunction and obesity

Obesity is a growing condition within the society and more patients, who have underlying obesity, are presenting with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction (PFD). The effect of obesity on general health has been well documented, and its impact on the cardiovascular, endocrine, and musculoskeletal systems has been extensively studied. There is now a growing body of evidence on the effects of obesity on the female urogenital system. It seems to influence the prevalence, presentation, assessment, management, and outcome of various types of LUTS and PFD. A holistic approach is needed to assess and manage these patients. A clear understanding of the functions of the pelvic floor and the way it can be affected by obesity is essential in providing holistic care to this group. A frank discussion about patient weight is required in the clinics handling PFD. A multimodal approach to weight loss would help improve PFD symptoms and progression. Patients with obesity should still be offered standard treatment options for all PFDs and should not be forced to lose weight as a prerequisite before starting treatment. However, they should also be made aware of the impediments that being overweight adds to their care and their expectations should be managed accordingly.

Can obesity impact mesh exposure rate after mid-urethral sling operation? Medium term follow-up

OBJECTIVE

To study mesh exposure rates among obese (BMI ≥ 30 kg/m²) vs non-obese women after mid-urethral sling (MUS) operation.

STUDY DESIGN

This retrospective cohort study included all patients who underwent MUS surgery for stress urinary incontinence April 2014-April 2021 in a tertiary-level university hospital. Data from obese and non-obese patients were compared.

RESULTS

A total of 120 (41 %) obese patients and 172 (59 %) non-obese patients who had mid-urethral sling surgery were compared. Of the cohort, 265 (90.7 %) underwent TVT-obturator, 15 (5.1 %) mini-sling TVT, and 12 (4.1 %) retro-pubic TVT. Diabetes mellitus was significantly more prevalent in the obese group (p =.01), without other demographic differences. Mesh post-operative exposure rate was 5.4 % during the study. The obese group had lower incidence of mesh exposure than the non-obese group (1.6 % vs 8.1 % respectively, p =.018). Mean follow-up was 51 months (range 8-87 months) without significant differences between groups (49.9 ± 21.2 vs 51.5 ± 22.3, p =.548). Pelvic organ prolapse, cystocele, and rectocele stages were significantly higher in non-obese patients. Similar numbers of post-menopausal women were in each group.

CONCLUSION

This follow-up after MUS surgery showed an association between obesity and lower rate of mesh exposure. Further research is needed to evaluate correlations between estrogen and mesh exposure.

Risk Factors for Intraoperative Bladder Perforation at the Time of Midurethral Sling Placement

OBJECTIVE

To evaluate patient-specific and perioperative factors that may be predictive of bladder perforation during midurethral sling placement.

METHODS

A retrospective chart review of women who underwent a midurethral sling procedure at our institution between 2013 and 2017 was completed. All cases with bladder perforation were included. Patient demographics and perioperative factors were explored for associations with perforation. Bivariate analysis was used to compare baseline characteristics between those with and without perforation. Logistic regression modeling was used to identify predictors of perforation and associations between bladder perforation and postoperative sequelae.

RESULTS

Four hundred and ten women had a urethral sling procedure at our institution between 2013 and 2017. Of these, 35 (9%) had evidence of bladder perforation on cystoscopy. This rate was higher for retropubic slings (15%) compared to transobturator slings (2%). Those with a perforation were younger (54 vs 61 years, P= .004) and had a lower average BMI (24.1 kg/m² vs 26.3 kg/m², P = .022). Other risk factors included lack of pre-existing apical prolapse (11% vs 4%, P = .012) and concomitant urethrolysis (27% vs 8%, P = .024). In multivariable analysis, age, BMI, and sling type were significantly associated with perforation. In univariate analysis, perforation was associated with postoperative lower urinary tract symptoms (OR 2.3, P = .21) and urinary tract infection within 30 days of surgery (OR 2.2, P = .047).

CONCLUSIONS

Intraoperative bladder perforation was associated with younger patient age and lower BMI. Additionally, bladder perforation is a risk factor for postoperative urinary tract infection and lower urinary tract symptoms.

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis

PURPOSE

Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women.

MATERIALS AND METHODS

A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded.

RESULTS

A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m² ) and nonobese (<30 kg/m² ). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women.

CONCLUSIONS

This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.

Impact of severe obesity on long-term success and complications of the retropubic midurethral sling

INTRODUCTION AND HYPOTHESIS

With conflicting evidence in the literature, we hypothesised that the long-term subjective outcomes of the retropubic midurethral sling (MUS) are the same in the severely obese and non-obese populations.

METHODS

A retrospective matched cohort study was performed on women with a BMI ≥ 35 and < 30 who had a retropubic MUS placed between 2010 and 2015 using telephone questionnaires. The primary outcome was the success rate of surgery defined by the Urogenital Distress Inventory Short Form (UDI-6) stress subscale. Statistical analysis was performed to test for associations between primary and secondary outcomes across the two groups.

RESULTS

Seventy-eight severely obese (SOG) and 74 non-obese (NOG) were recruited. At a median time from surgery of 3.8 years the success rate was 47.4% in the SOG compared to 64.9% in the NOG (p = 0.03). There was a 22% reduction in the odds of success with every 5 unit increase in BMI (p = 0.03). There were higher rates of mixed urinary incontinence preoperatively (60.3% vs. 37.8%, p = 0.006) and persistent urinary urge incontinence postoperatively (48.7% vs. 32.4% p = 0.04) in the severely obese. Lower PGI-I scores were obtained in the severely obese group indicating less improvement in symptoms from surgery. There was no difference in complication rates between the groups.

CONCLUSION

Long-term subjective outcomes from the retropubic MUS are lower in severely obese women than in non-obese women with no difference in complication rates. High satisfaction and recommendation rates were found in both groups.

Effect of Morbid Obesity on Midurethral Sling Efficacy for the Management of Stress Urinary Incontinence

OBJECTIVES

The aim of our study was to assess midurethral sling (MUS) failure rate in the morbidly obese (body mass index [BMI] ≥40 kg/m) population as compared with normal-weight individuals. Our secondary objective was to assess the difference in complication rates.

METHODS

This is a retrospective cohort study. We included all patients who underwent a synthetic MUS procedure from January 1, 2008, to December 31, 2015, in our health system. Failure was defined as reported stress urinary incontinence symptoms or treatment for stress urinary incontinence. Variables collected were BMI; smoking status; comorbidities; perioperative (≤24 hours), short-term (≤30 days), and long-term (>30 days) complications; and follow-up time. Statistics include analysis of variance, χ test, logistic regression, Kaplan-Meier method, and Cox regression.

RESULTS

There were 431 patients included in our analysis. Forty-nine patients were in class 3 with a BMI mean of 44.9 ± 5.07 kg/m. Median follow-up time was 52 months (range, 6-119 months). Class 3 obesity (BMI ≥40 kg/m) was the only group that had an increased risk of failure when compared with the normal-weight group (P = 0.03; odds ratio, 2.47; 95% confidence interval, 1.09-5.59). Obesity was not a significant predictor of perioperative, short-term, or long-term postoperative complications (P = 0.19, P = 0.28, and P = 0.089, respectively) after controlling for other comorbidities.

CONCLUSIONS

Patients in the class 3 obesity group who are treated with an MUS are 2 times as likely to fail when compared with those in the normal-weight category on long-term follow-up with similar low complication rates.

Comparing the effect of electroacupuncture treatment on obese and non-obese women with stress urinary incontinence or stress-predominant mixed urinary incontinence: A secondary analysis of two randomised controlled trials

OBJECTIVE

To explore whether obesity patients with a body mass index (BMI) of ≥25 kg/m2 who suffer from stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (S-MUI) show less improvement in urinary incontinence (UI) symptoms after electroacupuncture (EA) treatment compared with non-obese counterparts.

METHODS

This study was a secondary analysis of existing data. About 252 SUI patients and 250 S-MUI patients treated with the same EA regimen were assigned to one of the two groups: the obesity group for BMI ≥25 kg/m2 and the non-obesity group for BMI <25 kg/ m2 . The primary outcome was the proportion of treatment responders, defined as patients exhibiting a ≥50% reduction in 72-hours incontinence episode frequency, as measured by a 72-hours bladder diary at week 6 compared with baseline.

RESULTS

Of the 1004 randomised women, 129 obese women (86 SUI and 43 S-MUI) and 255 non-obese women (166 SUI and 89 S-MUI) treated with EA were included in a secondary analysis. The primary outcome was that 58.3% (74/127) of patients in the obesity group and 60.7% (150/247) of patients in the non-obesity group (difference 0.55%; 95% confidence interval, -10.01 to 11.11; P = .919) responded to treatment.

CONCLUSION

This study suggests that EA treatment may safely improve UI symptoms in both obese and non-obese patients, regardless of BMI category. Additionally, obesity status may not affect the efficacy of EA treatment on SUI or S-MUI among Chinese women.

SEAPI Incontinence Classification System: 1-Year Postoperative Results Following Midurethral Sling Placement

OBJECTIVE

There are limited long-term data that has examined postoperative quality-of-life measures following placement of midurethral sling (MUS) for stress urinary incontinence (SUI). The SEAPI incontinence questionnaire includes 5 data points that rate severity of specific urinary symptoms. Our aim was to describe changes in SEAPI questionnaire outcomes 1 year following sling placement.

METHODS

We retrospectively reviewed women who underwent MUS for SUI from 2005 to 2012. We included those women who had completed preoperative and postoperative (>12 months) SEAPI scores. Individual S, E, A, P, I score cure was defined as postoperative score of 0 (>0 preoperative). Logistic regression analysis was used to model the effects of patient characteristics on incontinence cure and S, E, A, P, I scores.

RESULTS

A total of 584 women were included. Median follow-up was 25.4 months (12-126.8 months). Follow-up duration and baseline S, P, and I scores were associated with significantly lower odds of overall incontinence cure, whereas rectocele grade has positive association (odds ratio, 1.31; P = 0.040). Type of sling did not impact overall incontinence cure or cure of individual SEAPI scores.

CONCLUSIONS

Preoperative S, P, and I scores had negative association with stress incontinence cure. Cure of individual S, E, A, P, I scores was impacted differently by various patient factors. The SEAPI questionnaire provides a unique profile of patient-reported and functional measures in women with SUI and may be helpful in those who undergo MUS.

Obesity and Stress Urinary Incontinence: Impact on Pathophysiology and Treatment

PURPOSE OF REVIEW

Obesity is highly prevalent and is associated with stress urinary incontinence (SUI). The purposes of this review are to assess the pathophysiology of SUI in the obese female and review the outcomes of weight loss and anti-incontinence surgery in this population.

RECENT FINDINGS

While increased intra-abdominal pressure appears to be the common pathophysiologic link between obesity and SUI, neurogenic and metabolic pathways have been proposed. Both surgical and non-surgical weight loss continue to have beneficial effects on SUI; however, long-term outcomes are largely absent. Midurethral sling (MUS) surgery is largely effective in the obese population, with a complication profile similar to that in non-obese women. Obesity has been shown to be a risk factor for failure of MUS. While weight loss should be the primary modality to improve SUI in the obese woman, MUS remains an effective and safe option in those women undertaking surgery.

Influence of body mass index on short-term subjective improvement and risk of reoperation after mid-urethral sling surgery

INTRODUCTION AND HYPOTHESIS

The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery.

METHODS

Data were retrieved from the national Danish Urogynaecological Database, including women with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3 months postoperatively. A reoperation was defined as any new surgical procedure for stress urinary incontinence performed within the study period.

RESULTS

During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence Questionnaire (ICI-Q) forms. 42.4% had a BMI < 25, 34.6% had BMI 25-30, 16.9% had BMI 30-35, and 6.0% BMI >35. The subjective improvement after surgery was high in all BMI categories and there were no differences between the categories. The overall cumulative hazard proportion at 2 years of follow-up was 1.9% (CI 95%: 1.6-2.3) and after 5 years 2.4% (CI 95%: 2.0-2.9). Adjusted for age, smoking, and use of alcohol, the cumulative hazard proportion after 2 years of follow-up was 3.2% (CI 95%: 1.6-6.2) for women with BMI >35 and after 5 years 4.0% (CI 95%: 2.0-7.7), which was the highest proportion of reoperation in the study. The crude hazard ratio was 1.84 (CI 95%: 0.89-3.83) women with BMI >35 and the adjusted hazard ratio was 1.94 (CI 95%: 0.92-4.09).

CONCLUSIONS

We found high subjective improvement after the first-time surgery unrelated to BMI. Women with a BMI over 35 had the highest proportion of reoperations, although this was not statistically significant.

Does the suburethral sling change its location?

OBJECTIVES

To ascertain whether a phenomenon of sling migration exists after suburethral sling placement, whether this might be responsible for suboptimal sling location and persistent incontinence, and whether a link exists between sling dislocation or migration and risk factors, such as obesity or age.

METHODS

The present prospective cohort study was carried out in a group of 244 patients who underwent retropubic sling implantation. Sling location was determined by means of pelvic floor ultrasound, and calculated relative to the individual patient's urethral length measured before the procedure. The sling location was visualized on 1 day, and 1 and 6 months post-surgery. Overweight/obese and elderly patients were analyzed separately to assess the possible influence of those factors on sling location.

RESULTS

The mean urethral length in the studied cohort was 28.76 ± 3.67 mm. The mean tape position 1 day post-surgery was 66.18 ± 8.43% of the urethral length, and it did not change 1 and 6 months post-surgery in the whole group. Similar results were obtained in elderly and overweight/obese patients.

CONCLUSIONS

Suboptimal sling location appears to result from incorrect surgical technique, and should be diagnosed and treated early after the primary surgery. Sling location does not change after mid-term follow up.

The Role of Obesity in Success and Complications in Patients Undergoing Retropubic Tension-Free Vaginal Tape Surgery

OBJECTIVES

The aim of this study was to examine the impact of obesity on the success rate of and complications from retropubic tension-free vaginal tape (TVT) midurethral slings for stress urinary incontinence (SUI).

METHODS

A retrospective, cohort study was performed on patients with retropubic TVT surgery between 2008 and 2014. Demographic, outcome, and complication data were obtained from electronic medical records and analyzed using logistic regression, analysis of variance, and multivariate regression analysis. Short-term (1-2 weeks) and long-term (2 months) outcomes were measured.

RESULTS

Two hundred twenty-seven patients were included; 100 (44%) were of normal weight, 71 (31%) were overweight, and 56 (24%) were obese. Overall SUI cure rates were high, although the obese group had a lower cure rate. Compared with normal weight, overweight patients had a 2.43 times higher odds (P = 0.14) of short-term complaints of persistent SUI, whereas obese patients had a 3.56 times higher odds (P = 0.03). Similar failure rates were seen at 2 months among the groups. Odds of intraoperative complications did not differ between overweight and normal weight (odds ratio [OR], 0.64; P = 0.319) and obese and normal weight (OR, 0.90; P = 0.83) patients. Postoperative complications did not differ between overweight and normal weight (OR, 0.40; P = 0.27) and obese and normal weight (OR, 1.45; P = 0.54) patients.

CONCLUSIONS

Obese women undergoing retropubic TVT surgery had a 3.56 increased odds of short-term complaints of SUI compared with normal weight patients, but 2-month failure rates were similar. Obese and overweight patients were equally likely to have complications from TVT.

Obesity and its implications on nononcological urological surgery

PURPOSE OF REVIEW

To review and summarize the current literature of the implications of obesity on nononcological urological surgery. We conducted a comprehensive search of the current literature with emphasis on the published literature in the last 18 months.

RECENT FINDINGS

Over time, obese patients have become a more common encounter in clinical practice. Obesity represents a considerable operative challenge and has been linked to a higher rate of postoperative complications. Data regarding surgery for incontinence are inconsistent. Nevertheless, the success rates in obese women are high, and complication rates are relatively low with comparable results to nonobese women. In renal surgery, percutaneous nephrolithotomy and minipercutaneous nephrolithotomy are feasible, well tolerated, and effective even in obese patients. However, certain precautions and availability of proper instruments are necessary.

SUMMARY

Although randomized clinical data are lacking and the results of many studies are inconsistent, evidence supports the feasibility and safety of different nononcological urological interventions in obese patients. Moreover, the success rates and the overall complication rates seem to be comparable to nonobese patients with some exceptions.

Antimicrobial and anti-biofilm properties of polypropylene meshes coated with metal-containing DLC thin films

A promising strategy to reduce nosocomial infections related to prosthetic meshes is the prevention of microbial colonization. To this aim, prosthetic meshes coated with antimicrobial thin films are proposed. Commercial polypropylene meshes were coated with metal-containing diamond-like carbon (Me-DLC) thin films by the magnetron sputtering technique. Several dissimilar metals (silver, cobalt, indium, tungsten, tin, aluminum, chromium, zinc, manganese, tantalum, and titanium) were tested and compositional analyses of each Me-DLC were performed by Rutherford backscattering spectrometry. Antimicrobial activities of the films against five microbial species (Candida albicans, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Enterococcus faecalis) were also investigated by a modified Kirby-Bauer test. Results showed that films containing silver and cobalt have inhibited the growth of all microbial species. Tungsten-DLC, tin-DLC, aluminum-DLC, zinc-DLC, manganese-DLC, and tantalum-DLC inhibited the growth of some strains, while chromium- and titanium-DLC weakly inhibited the growth of only one tested strain. In-DLC film showed no antimicrobial activity. The effects of tungsten-DLC and cobalt-DLC on Pseudomonas aeruginosa biofilm formation were also assessed. Tungsten-DLC was able to significantly reduce biofilm formation. Overall, the experimental results in the present study have shown new approaches to coating polymeric biomaterials aiming antimicrobial effect.

Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery

Importance

Elevated body mass index (BMI) has been proposed as a risk factor for morbidity and mortality among patients undergoing surgery. Conversely, an elevated BMI may confer a protective effect on perioperative morbidity.

Objective

To examine whether an elevated BMI is an independent risk factor for perioperative and postoperative infectious complications after free tissue transfer in head and neck reconstructive surgery.

Design, Setting, and Participants

This cohort study included patients undergoing major head and neck surgery requiring free tissue transfer at a tertiary care center. Data were collected for 415 patients treated from January 1, 2007, through December 31, 2014.

Main Outcomes and Measures

The outcome of interest was postoperative infection and complications after head and neck surgery using free flaps. Covariates considered for adjustment in the statistical model included alcohol consumption (defined as >5 drinks per day [eg, 360 mL of beer, 150 mL of wine, or 45 mL of 80-proof spirits]), type 2 diabetes, prior radiotherapy, anesthesia time, hypothyroidism, smoking, American Society of Anesthesiologists classification, antibiotic regimen received (defined as a standard regimen of a first- or second-generation cephalosporin with or without metronidazole hydrochloride vs an alternative antibiotic regimen for patients allergic to penicillin), and primary surgeon. A multiple logistic regression model was developed for the incidence of the infection end point as a function of elevated BMI (>30.0).

Results

Among the 415 patients included in this study (277 men [66.7%] and 138 women [33.2%]; mean [SD] age, 61.5 [13.9] years), type 2 diabetes and use of an alternative antibiotic regimen were found to be independently associated with increased infectious complications after free flap surgery of the head and neck, with estimated odds ratios of 2.78 (95% CI, 1.27-6.09) and 2.67 (95% CI, 1.14-6.25), respectively, in the multiple logistic regression model. However, a high BMI was not found to be statistically significant as an independent risk factor for postoperative infectious complication (estimated odds ratio, 1.19; 95% CI, 0.48-2.92).

Conclusions and Relevance

Elevated BMI does not seem to play a role as an independent risk factor in postoperative complications in free tissue transfer in head and neck surgery.

Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough?

INTRODUCTION AND HYPOTHESIS

We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support.

METHODS

A secondary analysis was performed using data from a case-control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5-24.9 kg/m²); overweight (25.0-29.9 kg/m²); and obese (≥30 kg/m²). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa.

RESULTS

The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p < 0.01), but not in normal weight or overweight women. Path model analysis showed a significant relationship between BMI and SUI through maximal cough pressure (indirect effect, p = 0.038), but not through MUCP (indirect effect, p = 0.243) or POP-Q point Aa (indirect effect, p = 0.410).

CONCLUSIONS

Our results support the first hypothesis that obesity is associated with SUI because of increased intravesical pressure, which therefore increases demand on the continence mechanism.

Five years after midurethral sling surgery for stress incontinence: obesity continues to have an impact on outcomes

INTRODUCTION AND HYPOTHESIS

The objective was to evaluate the impact of preoperative body mass index ≥30 on objective and subjective cure rates 5 years after midurethral sling surgery.

METHODS

Secondary analysis of the 5-year results of a randomized clinical trial evaluating tension-free vaginal tape vs transobturator tape surgery. Women (n = 176) were classified as obese or non-obese based on preoperative height and weight. Women self-reported symptoms and quality of life, and underwent standardized physical examinations and pad-testing. Categorical data were analyzed using Chi-squared or Fisher's exact tests, continuous data by Mann-Whitney U test. Primary outcome was objective cure defined as <1 g urine lost on pad-test at 5 years post-surgery. Secondary outcomes were subjective cure of incontinence, urinary urge incontinence symptoms, and quality of life scores.

RESULTS

Non-obese women had a higher rate of objective cure, 87.4 % (n = 83 out of 95) compared with 65.9 % (n = 29 out of 44) in the obese group (P = 0.003, risk difference [RD] 21.5 %, 95 % CI 5.9-37.0 %). Subjectively, non-obese women also reported higher rates of cure, 76.7 % (n = 89 out of 116) compared with 53.6 % (n = 30 out of 56) of obese women (P = 0.002, RD 23.2 %, 95 % CI 8.0-38.3 %). Overall rates of urge incontinence symptoms were similar in the two groups, but rates of bothersome symptoms were higher for obese women (58.9 % vs 42.1 %, P = 0.039, RD 16.8 % 95 % CI 1.1-32.6).

CONCLUSIONS

Five years after surgery, obese women continued to experience lower rates of cure compared with non-obese women.

The impact of obesity on outcomes and complications after top-down retropubic midurethral sling

AIMS

Obese women (BMI ≥ 30 kg/m² ) have been considered at higher risk for postoperative complications and failure in efficacy after SUI surgery. We compare the outcomes in this population with non-obese women (BMI < 30 kg/m² ) undergoing top-down retropubic polypropylene midurethral sling (RPM).

METHODS

We retrospectively identified 328 non-obese women and 294 obese women who underwent RPM. Evaluation included SEAPI (stress incontinence, emptying, anatomy, protection, inhibition) assessment and validated QoL questionnaires. Cure was defined as absence of subjective and objective SUI and no additional procedures to correct SUI. Perioperative details were abstracted from the hospital and clinic charts. Groups and outcomes were statistically compared.

RESULTS

All women had a minimum follow up of 12 months. Preoperative demographic variables, SEAPI scores, and QoL indices were similar between BMI groups. SUI cure rates were significantly higher for non-obese women (82.9% vs. 74.5%; P < 0.01). When controlling for concomitant pelvic surgery, cure rates were not statistically different (76.9% vs. 73.7%; P = 0.65). Statistically significant improvement in SEAPI scores and QoL indices was achieved in both groups. Overall, obese women had no increase in complications compared with the non-obese. The chance of passing an initial postoperative voiding trial was statistically higher in the obese group.

CONCLUSIONS

Obese women have similar success rates and significant improvement in QoL as non-obese women after RPM. Obesity alone does not appear to be a risk factor for additional complications during sling surgery and obese women may have earlier return to normal voiding after surgery.