Effect of morbid obesity on mid-urethral sling effecacy for the management of stress urinary incontinence.

Objectives: Mid-urethral slings (MUS) are the most widely accepted and studied minimally invasive procedure for the management of stress urinary incontinence (SUI) (1). However, studies have suggested decrease in efficacy of MUS procedures in the obese patients (2). In our urban population, we are encountering an increasing number of morbidly obese patients (BMI≥40) presenting with stress urinary incontinence interested in surgical management. The aim of our study was to assess the success rate of MUS in the morbidly obese patients. Our secondary outcome was to assess difference in complication rates between patients with BMI≥40 and \u3c40. Methods: This is a retrospective chart review. We collected data on all patients that have undergone a sling procedure between 2008-2015 in our health system. Failure was defined as reported SUI symptoms or treatment for SUI. Variables collected were BMI, smoking status, comorbidities, peri-operative complications (within 24hrs), short term (within 30days) and long term complications (\u3e30days) and the follow-up time. Analyses included ANOVA, Chi-square test, logistic, Kaplan Meier method and Cox regression. Results: We identified 565 patients, 130 were eliminated as they underwent a sling procedure other than MUS and for follow-up time \u3c6 months. 435 were included in our analysis, 49 patients were morbidly obese (mean=44.9 +/-5.07), 164 with BMI of 30-39 (mean=33.6 +/-2.63), 123 with BMI of 25-29.9 (mean= 27.4 +/-1.13) and 99 with BMI ≤25 (mean=23 +/-1.68). Our mean follow-up time was 52 months. There was no difference in failure rate between normal weight, overweight and class 1 and 2 obesity groups even after controlling for potential confounders such as diabetes mellitus (DM), smoking status, or chronic obstructive pulmonary disease (COPD) (p=0.18). Morbid obesity (BMI\u3e40) was associated with increased risk of failure when compared to the normal weight category (p=0.04, OR: 2.38, CI:1.05-5.39). COPD independently was associated with an increased risk of failure, odds ratio p=0.05, OR=1.72, CI=0.98-2.95). BMI category was not a significant predictor of peri-operative, short-term post-operative or long-term post-operative complications (p=0.33, p=0.16 and p=0.15 respectively) and also after controlling for other comorbidities as potential confounders. Conclusions: BMI has significant impact on MUS failure in the morbidly obese patients when compared to the normal weight category. This effect was not seen in overweight and Class 1 and 2 obesity categories. COPD independently and after stratification based on BMI category was associated with a higher failure rate and recurrence of stress urinary incontinence

Effect of Morbid Obesity on Midurethral Sling Efficacy for the Management of Stress Urinary Incontinence.

OBJECTIVES: The aim of our study was to assess midurethral sling (MUS) failure rate in the morbidly obese (body mass index [BMI] ≥40 kg/m) population as compared with normal-weight individuals. Our secondary objective was to assess the difference in complication rates. METHODS: This is a retrospective cohort study. We included all patients who underwent a synthetic MUS procedure from January 1, 2008, to December 31, 2015, in our health system. Failure was defined as reported stress urinary incontinence symptoms or treatment for stress urinary incontinence. Variables collected were BMI; smoking status; comorbidities; perioperative (≤24 hours), short-term (≤30 days), and long-term (\u3e30 days) complications; and follow-up time. Statistics include analysis of variance, χ test, logistic regression, Kaplan-Meier method, and Cox regression. RESULTS: There were 431 patients included in our analysis. Forty-nine patients were in class 3 with a BMI mean of 44.9 ± 5.07 kg/m. Median follow-up time was 52 months (range, 6-119 months). Class 3 obesity (BMI ≥40 kg/m) was the only group that had an increased risk of failure when compared with the normal-weight group (P = 0.03; odds ratio, 2.47; 95% confidence interval, 1.09-5.59). Obesity was not a significant predictor of perioperative, short-term, or long-term postoperative complications (P = 0.19, P = 0.28, and P = 0.089, respectively) after controlling for other comorbidities. CONCLUSIONS: Patients in the class 3 obesity group who are treated with an MUS are 2 times as likely to fail when compared with those in the normal-weight category on long-term follow-up with similar low complication rates