Does body mass index influence the outcome of midurethral sling procedures for stress urinary incontinence?
OBJECTIVE
Whether midurethral sling (MUS) procedures are as effective in obese women as they are in women of normal weight is still a matter of controversy. The objective of this study was to determine if body mass index (BMI) influences the outcome of MUS procedures for stress urinary incontinence (SUI).


METHODS
We searched electronic databases including EMBASE, MEDLINE, Web of Science and Ovid evidence-based medicine reviews to identify studies that explored the association between BMI and outcomes of MUS procedures. The studies were rated using the Newcastle-Ottawa scale; the meta-analysis was performed using Review Manager 5.3 software.


RESULTS
This review included 11 studies, 6 prospective cohort studies and 5 retrospective studies, with a total of 2,846 patients. The objective success rates of MUS in patients with BMI >25 kg/m2(overweight and obese) were lower than in patients with BMI 18.5 - <25 kg/m2(normal weight; RR = 0.93, 95 % CI 0.89 - 0.97; P = 0.002). The objective success rates were not significantly different between the overweight group (BMI 25 - <30 kg/m2) and the obese group (BMI ≥30 kg/m2; RR = 0.95, 95 % CI 0.89 - 1.01; P = 0.08). There were no significant differences in subjective outcomes among the different BMI groups: BMI ≥25 kg/m2versus 18.5 - <25 kg/m2(RR = 1.03, 95 % CI 0.97 - 1.10; P = 0.29), and BMI ≥30 kg/m2versus 25 - <30 kg/m2(RR = 0.98, 95 % CI 0.92 - 1.04; P = 0.55).


CONCLUSIONS
The objective success rates of MUS were lower in overweight and obese patients; however, the subjective outcomes of MUS were not significantly different among normal weight, overweight and obese patients. The MUS procedure is as effective in obese women as in women of normal weight, and therefore surgeons should not consider BMI >25 kg/m2as a risk factor when discussing the suitability of the MUS procedure in a patient with SUI.
College of Architecture and Environment, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Ziyuan
Z
Xia
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Jialei
J
Qian
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Yuntian
Y
Chen
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Banghua
B
Liao
Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China. luodeyi1985@163.com.
Deyi
D
Luo
D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*
Body mass index; Midurethral slings; Stress urinary incontinence