title: Tension-free vaginal tape procedure is an ideal treatment for obese patients.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effect of obesity on the success of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence. Specifically, do patients with a body mass index (BMI) of 35 kg/m(2) or greater have a lower cure rate of stress urinary incontinence?
  
  
  METHODS
  This retrospective cohort study identified 35 patient pairs who had undergone TVT in Winnipeg, Manitoba, Canada, for stress urinary incontinence from November 1999 to July 2001. Obese patients (defined as BMI greater than or equal to 35 kg/m(2)) were paired with nonobese patients (defined as BMI less than or equal to 30 kg/m(2)). The subjects were matched for age (within 5 years) and prior continence surgeries. Patients with a maximum urethral closure pressure of less than or equal to 20 cm H(2)O were excluded. Follow-up was either by objective cough stress test or subjective cure assessed by telephone interview. Cure was defined as no postoperative stress incontinence. Statistical analysis was performed by conditional logistic regression for matched controls.
  
  
  RESULTS
  The follow-up range was 6 to 24 months. There were seven failures in all, four in obese and three in nonobese patients, giving cure rates of 88.6% and 91.4%, respectively. This difference was not statistically significant (P>.05). There were five bladder perforations (identified at the time of the procedure), all occurring in nonobese patients (P< .05).
  
  
  CONCLUSIONS
  These data do not demonstrate a difference in cure of TVT in obese versus nonobese patients. Given the finding of fewer complications, this procedure may be an ideal surgical treatment modality for stress urinary incontinence in obese women.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, St Boniface General Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Lovatsis
authors.forename: Chander
authors.initials: C
authors.lastname: Gupta
authors.forename: Erin
authors.initials: E
authors.lastname: Dean
authors.forename: Francis
authors.initials: F
authors.lastname: Lee
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009765:Obesity / Q000150:complications*; D011336:Probability; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000601:surgery*; D014563:Urodynamics; D013519:Urogenital Surgical Procedures / Q000379:methods*; D014621:Vagina / Q000601:surgery*