title: Clinical impact of body mass index on the outcome of the SPARC-sling system for the treatment of female stress urinary incontinence.
abstract: OBJECTIVE
  Of this observational study was to evaluate the clinical outcome of the suprapubic arc (SPARC)-sling system in women with stress urinary incontinence according to body mass index (BMI).
  
  
  METHODS
  A total of 151 women underwent SPARC between June 2001 and March 2009 at a single tertiary academic center. A complete urodynamic investigation was performed preoperatively. A minimum follow-up of 12 months was required, which left data of 93 individuals for analyses. Participants were divided into the following: A, non-obese (BMI 18.5 to <25 kg/m(2)), B, overweight (BMI 25 to <30 kg/m(2)), and C, obese (BMI 30-35 kg/m(2)). Objective and subjective cure rates, as well as overall success rate and self-perceived severity of bother, were measured. Moreover, participants were asked about their satisfaction after surgery.
  
  
  RESULTS
  Median follow-up was 7.6 years. Mean number of pads/day, pad test, and self-perceived severity of bother were significantly reduced overall, as well as in each BMI category (P < 0.001). In multivariable analyses, BMI was not an independent predictor of objective cure rate, coded either as continuous (P = 0.108) or as categorical variable (P for trend 0.301). Similarly, BMI was not an independent predictor of subjective cure rate, both coded as continuous (P = 0.475) and as categorical variable (P for trend 0.690). Overall, 92% (A), 85% (B), and 80% (C) of participants were satisfied with the surgical outcome at follow-up, respectively.
  
  
  CONCLUSIONS
  BMI failed to achieve independent predictor status regarding objective and subjective cure rate at follow-up. A high BMI is not a contraindication to SPARC, more studies are recommended to confirm these findings.
authors.affiliation: Department of Urology, Medical University of Graz (MUG), Auenbruggerplatz 7, 8036, Graz, Austria. bader1971@gmx.at
authors.forename: Badereddinn
authors.initials: B
authors.lastname: Mohamad Al-Ali
authors.forename: Georg C
authors.initials: GC
authors.lastname: Hutterer
authors.forename: Erika
authors.initials: E
authors.lastname: Puchwein
authors.forename: Karl
authors.initials: K
authors.lastname: Pummer
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Günter
authors.initials: G
authors.lastname: Primus
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology; D013520:Urologic Surgical Procedures / Q000379:methods*