title: Does obesity impact the success of an InterStim test phase for the treatment of refractory urge urinary incontinence in female patients?
abstract: OBJECTIVE
  Some providers believe obesity may be a relative contraindication for InterStim; however, the relationship between obesity and treatment outcome has not been evaluated. Our objectives were to compare the test phase (stage 1) success and complications of obese versus nonobese women undergoing a 2-stage InterStim procedure for refractory urge urinary incontinence (UUI).
  
  
  METHODS
  We conducted a retrospective cohort study of obese and nonobese women who underwent stage 1 InterStim for refractory UUI. We compared the stage 1 success, defined as undergoing stage 2 generator implantation after demonstrating improvement of 50% or greater during test phase and intraoperative and postoperative complications within 1 year between obese and nonobese cohorts.
  
  
  RESULTS
  Of 149 subjects, 80 (53.7%) were obese (body mass index, 37.3±5.87 kg/mg), and 69 (46.3%) were nonobese (body mass index, 25.6±2.82 kg/m). The overall stage 1 success was 81%. No statistically significant difference existed in stage 1 success between obese and nonobese cohorts (83% vs 78%, P=0.52). In a logistic regression model controlling for obesity, age, preoperative incontinence episodes per 24 hours, psychiatric diagnoses, arthritis, and diabetes mellitus, age per decade was the only variable significantly associated with stage 1 InterStim success (odds ratio, 0.61; 95% confidence interval, 0.39-0.96). Complications were also similar between cohorts (obese 20% vs nonobese 13%, P=0.26).
  
  
  CONCLUSIONS
  In women undergoing staged InterStim therapy, stage 1 success and complications were similar between obese versus nonobese women. These data suggest that obesity should not be considered a limiting factor when determining whether a patient is a candidate for InterStim therapy for treatment of refractory UUI.
authors: Division of Urogynecology, Department of Obstetrics and Gynecology, Duke Urogynecology, Durham, NC 27707, USA. pamela.j.levin@gmail.com
authors: Pamela June
authors: PJ
authors: Levin
authors: Jennifer M
authors: JM
authors: Wu
authors: Nazema Y
authors: NY
authors: Siddiqui
authors: Cindy L
authors: CL
authors: Amundsen
mesh_terms: D000368:Aged; D015992:Body Mass Index; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome; D053202:Urinary Incontinence, Urge / Q000150:complications* / Q000628:therapy*