title: The impact of obesity on outcomes and complications after top-down retropubic midurethral sling.
abstract: OBJECTIVE
  Obese women (BMI ≥ 30 kg/m2) have been considered at higher risk for postoperative complications and failure in efficacy after SUI surgery. We compare the outcomes in this population with non-obese women (BMI < 30 kg/m2) undergoing top-down retropubic polypropylene midurethral sling (RPM).
  
  
  METHODS
  We retrospectively identified 328 non-obese women and 294 obese women who underwent RPM. Evaluation included SEAPI (stress incontinence, emptying, anatomy, protection, inhibition) assessment and validated QoL questionnaires. Cure was defined as absence of subjective and objective SUI and no additional procedures to correct SUI. Perioperative details were abstracted from the hospital and clinic charts. Groups and outcomes were statistically compared.
  
  
  RESULTS
  All women had a minimum follow up of 12 months. Preoperative demographic variables, SEAPI scores, and QoL indices were similar between BMI groups. SUI cure rates were significantly higher for non-obese women (82.9% vs. 74.5%; P < 0.01). When controlling for concomitant pelvic surgery, cure rates were not statistically different (76.9% vs. 73.7%; P = 0.65). Statistically significant improvement in SEAPI scores and QoL indices was achieved in both groups. Overall, obese women had no increase in complications compared with the non-obese. The chance of passing an initial postoperative voiding trial was statistically higher in the obese group.
  
  
  CONCLUSIONS
  Obese women have similar success rates and significant improvement in QoL as non-obese women after RPM. Obesity alone does not appear to be a risk factor for additional complications during sling surgery and obese women may have earlier return to normal voiding after surgery.
authors: Department of Urology, Louisiana State University Health-Shreveport, Shreveport, Louisiana.
authors: Umar
authors: U
authors: Karaman
authors: Department of Urology, University of Florida, Gainesville, Florida.
authors: Kevin J
authors: KJ
authors: Campbell
authors: School of Allied Health, Louisiana State University Health-Shreveport, Shreveport, Louisiana.
authors: Clifton F
authors: CF
authors: Frilot
authors: Department of Urology, Louisiana State University Health-Shreveport, Shreveport, Louisiana.
authors: Alex
authors: A
authors: Gomelsky
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014554:Urination / Q000502:physiology
keywords: complications; midurethral sling; obesity; outcomes; stress urinary incontinence