Log in

Incontinence surgery in obese women: comparative analysis of short- and long-term outcomes with a transobturator sling

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Midurethral slings (MUS) are still discussed in complex incontinence situations, such as obesity, lacking sustained efficacy validation in this particular sub-population. We hypothesized that the outcomes of a transobturator MUS, such as TVT-O, do not differ according to body mass index (BMI) over a 4-year period.

Methods

We conducted a retrospective analysis of 281 women who underwent TVT-O at our institution, between 2004 and 2012. Patients were stratified into obese (BMI ≥ 30 kg/m2) or non-obese (BMI < 30 kg/m2). We compared preoperative and postoperative parameters, including objective cure (negative stress test), complications, and quality of life scores. Data were collected at 0, 6, 12, 24, and 48 months. We used Fisher’s exact test for categorical variables and Student’s t test or the Mann–Whitney U test for continuous variables.

Results

Baseline characteristics of the obese (n = 122) and non-obese groups (n = 159) were similar. We found no significant differences between groups in terms of objective cure rates at all follow-up evaluations, with 95.8 % and 95 % at 48 months in the non-obese and obese groups respectively. There were no significant differences in the cumulative complication rates of both groups. Quality of life assessment also showed no significant differences between groups at all follow-up visits. At 48 months our follow-up rate was 59 % (n = 96) and 60.4 % (n = 72) in the non-obese and obese group respectively (p = 0.9).

Conclusions

The TVT-O procedure is effective and safe in the long term for stress incontinence treatment, regardless of BMI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hunskaar S, Burgio K, Diokno A et al (2003) Epidemiology and natural history of urinary incontinence in women. Urology 62 [Suppl 1]:16–23

    Article  PubMed  Google Scholar 

  2. Hunskaar S (2008) A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn 27:749–757

    Article  PubMed  Google Scholar 

  3. Mommsen S, Foldspang A (1994) Body mass index and adult female urinary incontinence. World J Urol 12:319–322

    Article  CAS  PubMed  Google Scholar 

  4. Subak LL, Richter HE, Hunskaar S (2009) Obesity and urinary incontinence: epidemiology and clinical research update. J Urol 182:S2–S7

    Article  PubMed Central  PubMed  Google Scholar 

  5. Flegal KM, Carroll MD, Kit BK et al (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307:491–497

    Article  PubMed  Google Scholar 

  6. Global Health Observatory (GHO) (2013) Obesity 2008. World Health Organization

  7. Ulmsten U, Petros P (1995) Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 29(1):75–82

    Article  CAS  PubMed  Google Scholar 

  8. Ward KL, Hilton P, UK and Ireland TVT Trial Group (2008) A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG 115:226–233

    Article  CAS  PubMed  Google Scholar 

  9. Novara G, Artibani W, Barber MD et al (2010) Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol 58:218–238

    Article  PubMed  Google Scholar 

  10. Haverkorn R, Williams B, Kubricht W III et al (2011) Is obesity a risk factor for failure and complications after surgery for incontinence and prolapse in women? J Urol 185:987–992

    Article  PubMed  Google Scholar 

  11. Abdel-Fattah M, Familusi A, Ramsay I et al (2010) Preoperative determinants for failure of transobturator tapes in the management of female urodynamic stress incontinence. Int J Gynaecol Obstet 110:18–22

    Article  PubMed  Google Scholar 

  12. Hellberg D, Holmgren C, Lanner L et al (2007) The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. Int Urogynecol J 18:423–429

    Article  Google Scholar 

  13. Abdel-Fattah M, Ramsay I, Pringle S et al (2010) Randomized prospective single-blinded study comparing ‘inside-out’ versus ‘outside-in’ transobturator tapes in the management of urodynamic stress incontinence: 1 year outcomes. BJOG 117:870–878

    Article  CAS  PubMed  Google Scholar 

  14. Heinonen P, Ala-Nissila S, Raty R et al (2013) Objective cure rates and patient satisfaction after the transobturator tape procedure during 6.5 year follow-up. J Minim Invasive Gynecol 20:73–78

    Article  PubMed  Google Scholar 

  15. Liu PE, Su CH, Lau HH et al (2011) Outcome of tension-free obturator tape procedures in obese and overweight women. Int Urogynecol J 22:259–263

    Article  PubMed  Google Scholar 

  16. Killingsworth LB, Wheeler TL 2nd, Burgio KL et al (2009) One year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women. Int Urogynecol J Pelvic Floor Dysfunct 20:1103–1108

    Article  PubMed Central  PubMed  Google Scholar 

  17. Mukherjee K, Constantine G (2001) Urinary stress incontinence in obese women: tension-free vaginal tape is the answer. BJU Int 88:881–883

    Article  CAS  PubMed  Google Scholar 

  18. Esin S, Salman MC, Ozyuncu O et al (2011) Surgical outcome of transobturator tape procedure in obese and non-obese women. J Obstet Gynaecol 31:645–649

    Article  CAS  PubMed  Google Scholar 

  19. Tchey DU, Kim WT, Kim YJ et al (2010) Influence of obesity on short-term surgical outcome of the transobturator tape procedure in patients with stress urinary incontinence. Int Neurourol 14:13–19

    Article  Google Scholar 

  20. Rafii A, Darai E, Haab F et al (2003) Body mass index and outcome of tension-free vaginal tape. Eur Urol 43:288–292

    Article  PubMed  Google Scholar 

  21. Ku JH, Oh JG, Shin JW et al (2006) Outcome of mid-urethral sling procedures in Korean women with stress urinary incontinence according to body mass index. Int J Urol 13:279–284

    Google Scholar 

  22. Brennand EA, Tang S, Williamson T et al (2014) Twelve-month outcomes following midurethral sling procedures for stress incontinence: impact of obesity. BJOG. doi:10.1111/1471-0528.13132

    Google Scholar 

  23. Hwang IS, Yu JH, Chung JY et al (2012) One-year outcomes of mid-urethral procedures for stress urinary incontinence according to body mass index. Korean J Urol 53:171–177

    Article  PubMed Central  PubMed  Google Scholar 

  24. Jeong SJ, Lee HS, Lee JK et al (2014) The long-term influence of body mass index on the success rate of mid-urethral sling surgery among women with stress urinary incontinence or stress-predominant mixed incontinence: comparisons between retropubic and transobturator approaches. PLoS One 9(11):e113517. doi:10.1371/journal.pone.0113517

    Article  PubMed Central  PubMed  Google Scholar 

  25. WHO (2000) Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. World Health Organization, Geneva

    Google Scholar 

  26. Tamanini JT, D’Ancona CA, Botega NJ et al (2003) Validation of the Portuguese version of the King’s Health Questionnaire for urinary incontinent women. Rev Saude Publica 37(2):203–211

    Article  PubMed  Google Scholar 

  27. Ghoniem G, Stanford E, Kenton K et al (2008) Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J Pelvic Floor Dysfunct 19:5–33

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Noblett KL, Jensen JK, Ostergard DR et al (1997) The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct 8:323–326

    Article  CAS  PubMed  Google Scholar 

  29. Bullock TL, Ghoneim G, Klutke CG et al (2006) Advances in female stress urinary incontinence: midurethral slings. BJU 98 [Suppl 1]:32–40

    Article  Google Scholar 

  30. De Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724–730

  31. Ogah J, Cody JD, Rogerson L (2009) Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 4:CD006375

    PubMed  Google Scholar 

Download references

Financial disclaimer

None.

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Inês Pereira.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pereira, I., Valentim-Lourenço, A., Castro, C. et al. Incontinence surgery in obese women: comparative analysis of short- and long-term outcomes with a transobturator sling. Int Urogynecol J 27, 247–253 (2016). https://doi.org/10.1007/s00192-015-2820-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-015-2820-8

Keywords

Navigation