title: Minimally invasive treatment of female stress urinary incontinence with the adjustable single-incision sling system (AJUST ™) in an elderly and overweight population.
abstract: The prevalence of urinary incontinence is increasing. Two major risk factors are overweight and age. We present objective and subjective cure rates of elderly and overweight patients treated with an adjustable single-incision sling system (AJUST™, C.R. BARD, Inc.).
  
  
  
  Between 04/2009 and 02/2012 we treated 100 female patients with the single incision sling. Patients were retrospectively evaluated by Stamey degree of incontinence, cough test, pad use, and overall satisfaction. The primary outcomes of the study were objective and subjective cure rates, secondary outcomes were the safety profile of the sling and complications.
  
  
  
  The overall success rate in this population was 84.6% with a mean follow-up of 9.3 months. The average usage of pads per day decreased from 4.9 to 1.6 and was significantly lower in patients with a BMI <30 (p=0.004). Postoperative residual SUI was also lower in patients with a BMI <30 (p=0.006). Postoperative satisfaction was better in patients with a lower BMI, but this difference did not reach a level of significance (p=0.055). There were no complications such as bleeding, bladder injury, or tape infection.
  
  
  
  In elderly and obese patients a considerable success rate is achievable with this quick and minimal invasive procedure. However, the success rate shows a clear trend in favor of a lower body-mass-index. The cut-off point has been identified at a BMI of 30. The AJUST™ system can be regarded as safe and beneficial for elderly and obese patients.
authors.affiliation: Department of Urology and Neuro-Urology, University Hospital Bonn, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Anding
authors.affiliation: Department of Urology, Klinikum Ibbenbueren GmbH, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Schoen
authors.affiliation: Department of Urology and Neuro-Urology, University Hospital Bonn, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: Kirschner-Hermanns
authors.affiliation: Department of Urology and Neuro-Urology, University Hospital Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Fisang
authors.affiliation: Department of Urology and Neuro-Urology, University Hospital Bonn, Germany.
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Müller
authors.affiliation: Department of Urology and Neuro-Urology, University Hospital Bonn, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Latz
keywords: Body Mass Index ; Suburethral Slings; Urinary Incontinence, Stress