Five years after midurethral sling surgery for stress incontinence: obesity continues to have an impact on outcomes.
OBJECTIVE
The objective was to evaluate the impact of preoperative body mass index ≥30 on objective and subjective cure rates 5 years after midurethral sling surgery.


METHODS
Secondary analysis of the 5-year results of a randomized clinical trial evaluating tension-free vaginal tape vs transobturator tape surgery. Women (n = 176) were classified as obese or non-obese based on preoperative height and weight. Women self-reported symptoms and quality of life, and underwent standardized physical examinations and pad-testing. Categorical data were analyzed using Chi-squared or Fisher's exact tests, continuous data by Mann-Whitney U test. Primary outcome was objective cure defined as <1 g urine lost on pad-test at 5 years post-surgery. Secondary outcomes were subjective cure of incontinence, urinary urge incontinence symptoms, and quality of life scores.


RESULTS
Non-obese women had a higher rate of objective cure, 87.4 % (n = 83 out of 95) compared with 65.9 % (n = 29 out of 44) in the obese group (P = 0.003, risk difference [RD] 21.5 %, 95 % CI 5.9-37.0 %). Subjectively, non-obese women also reported higher rates of cure, 76.7 % (n = 89 out of 116) compared with 53.6 % (n = 30 out of 56) of obese women (P = 0.002, RD 23.2 %, 95 % CI 8.0-38.3 %). Overall rates of urge incontinence symptoms were similar in the two groups, but rates of bothersome symptoms were higher for obese women (58.9 % vs 42.1 %, P = 0.039, RD 16.8 % 95 % CI 1.1-32.6).


CONCLUSIONS
Five years after surgery, obese women continued to experience lower rates of cure compared with non-obese women.
From the Department of Obstetrics & Gynecology, Division of Urogynecology, Foothills Medical Centre, University of Calgary, 4th Floor, North Tower, 1403-29th Street, Calgary, Alberta, T2N 2T9, Canada. erin.brennand@albertahealthservices.ca.
Erin A
EA
Brennand
From the Department of Obstetrics & Gynecology, Division of Urogynecology, Foothills Medical Centre, University of Calgary, 4th Floor, North Tower, 1403-29th Street, Calgary, Alberta, T2N 2T9, Canada.
Selphee
S
Tang
From the Department of Obstetrics & Gynecology, Division of Urogynecology, Foothills Medical Centre, University of Calgary, 4th Floor, North Tower, 1403-29th Street, Calgary, Alberta, T2N 2T9, Canada.
Colin
C
Birch
From the Department of Obstetrics & Gynecology, Division of Urogynecology, Foothills Medical Centre, University of Calgary, 4th Floor, North Tower, 1403-29th Street, Calgary, Alberta, T2N 2T9, Canada.
Magnus
M
Murphy
From the Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada.
Sue
S
Ross
From the Department of Obstetrics & Gynecology, Division of Urogynecology, Foothills Medical Centre, University of Calgary, 4th Floor, North Tower, 1403-29th Street, Calgary, Alberta, T2N 2T9, Canada.
Magali
M
Robert
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D053825:Suburethral Slings / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000150:complications* / Q000601:surgery*
Midurethral sling; Obesity; Tension-free vaginal tape; Transobturator tape; Urinary incontinence
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