title: The influence of the modifiable life-style factors body mass index and smoking on the outcome of mid-urethral sling procedures for female urinary incontinence.
abstract: OBJECTIVE
  The aim of this observational study was to investigate the influence of body mass index (BMI) smoking and age on the cure rate, rate of complications and patient satisfaction with mid-urethral sling (MUS) procedures.
  
  
  METHODS
  Pre-, peri- and postoperative (8 weeks and 1 year) data were retrieved from the Swedish National Register for Gynecological Surgery of MUS procedures (retropubic procedures, n = 4,539; transobturator procedures, n =1,769) performed between January 2006 and December 2011. Multiple logistic regression analyses were performed between the outcome variables and BMI and smoking, presented as adjusted odds ratios (adjOR) with 95 % confidence interval (CI).
  
  
  RESULTS
  Subjective 1-year cure rate was 87.4 % for all MUS procedures (88.3 % with the retropubic technique and 85.2 % with the transobturator technique (p = 0.002). Preoperative daily urinary leakage and urgency were more common with increasing BMI, but surgery reduced symptoms in all BMI groups. Lower cure rate was seen in women with a BMI >30 (0.49; CI 0.33-0.73), in diabetics (0.50; CI 0.35-0.74) and women aged > 80 years (0.18; CI 0.06-0.51). Perioperative complications were more common in the retropubic group (4.7 % vs 2.3 % in the transobturator group, p=0.001) and in women with BMI < 25. Smoking did not influence any of the outcome variables.
  
  
  CONCLUSIONS
  The overall 1-year cure rate for MUS procedures was 87 %, but was negatively influenced by BMI >30, diabetes and age > 80 years. Perioperative complications were more common with the retropubic procedure than with the transobturator technique, and in women with a BMI < 25. Smoking did not impact on any of the studied outcome variables.
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, 416 85, Gothenburg, Sweden.
authors.forename: Katja Stenström
authors.initials: KS
authors.lastname: Bohlin
authors.forename: Maud
authors.initials: M
authors.lastname: Ankardal
authors.forename: Corinne
authors.initials: C
authors.lastname: Pedroletti
authors.forename: Håkan
authors.initials: H
authors.lastname: Lindkvist
authors.forename: Ian
authors.initials: I
authors.lastname: Milsom
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology*; D053825:Suburethral Slings / Q000009:adverse effects; D013548:Sweden; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000601:surgery*