title: Twelve-month outcomes following midurethral sling procedures for stress incontinence: impact of obesity.
abstract: OBJECTIVE
  To evaluate impact of body mass index (BMI) ≥30 on objective and subjective cure rates 12 months after midurethral sling surgery.
  
  
  METHODS
  Secondary analysis.
  
  
  METHODS
  Three hospitals in Calgary, Canada, 2005-07.
  
  
  METHODS
  A total of 182 women enrolled in a randomised control trial of tension-free vaginal tape versus transobturator tape.
  
  
  METHODS
  Women were classified as obese or nonobese from height and weight on day of surgery. Women underwent postoperative standardised pad tests, self-reporting of urinary incontinence, and quality of life scores. Categorical data compared with chi-square or Fisher's exact, continuous data compared with Mann-Whitney U test.
  
  
  METHODS
  Primary outcome was objective cure, defined as <1 g urine loss on postoperative 1-hour pad test. Secondary outcomes were subjective cure of incontinence (no stress incontinence in previous 7 days), presence of urinary urgency in previous 7 days, Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores, and surgical complication rates.
  
  
  RESULTS
  Objective cure differed, with 85.6% of nonobese women leaking <1 g on 1-hour pad test, versus 67.8% of obese women (P = 0.006, risk difference [RD] 17.8%, 95% confidence interval [95% CI] 4.2-31.4%). Subjective cure was 85.8% for nonobese women versus 70.7% for obese women (P = 0.016, RD 15.1%, 95% CI 1.9-28.4%). For both groups, improvement was seen for postoperative UDI-6 (median -33.3 [-44.4 to -22.2] and -27.2 [-44.4 to -16.7]) and IIQ-7 scores (median -26.2 [-45.2 to -14.3] and -23.8 [-42.9 to -14.3]). No differences existed in rates of operative complications between the two groups.
  
  
  CONCLUSIONS
  Twelve months after midurethral sling surgery, obese women experience lower rates of cure than those who are nonobese.
authors.affiliation: Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada.
authors.forename: E A
authors.initials: EA
authors.lastname: Brennand
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Tang
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Williamson
authors.affiliation: Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Birch
authors.affiliation: Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Murphy
authors.affiliation: Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Robert
authors.affiliation: Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Ross
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011788:Quality of Life; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*
keywords: Midurethral sling; obesity; tension-free vaginal tape; transobturator tape; urinary incontinence