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Five years after midurethral sling surgery for stress incontinence: obesity continues to have an impact on outcomes

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Abstract

Introduction and hypothesis

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.

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Acknowledgments

Members of the Calgary Women’s Pelvic Health Research Group: Richard Baverstock, Colin Birch, Penny Brasher, Erin Brennand, Kevin Carlson, Dave Cenaiko, Lorel Dederer, Philip Jacobs, Doug Lier, Tom Mainprize, Magnus Murphy, Magali Robert, Sue Ross, Cheryl Swaby, Selphee Tang, and Tyler Williamson.

Author information

Authors and Affiliations

  1. 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 A Brennand, Selphee Tang, Colin Birch, Magnus Murphy & Magali Robert

  2. From the Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada

    Sue Ross

Authors
  1. Erin A Brennand
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  2. Selphee Tang
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  3. Colin Birch
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  4. Magnus Murphy
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  5. Sue Ross
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  6. Magali Robert
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for the Calgary Women’s Pelvic Health Research Group

Corresponding author

Correspondence to Erin A Brennand.

Ethics declarations

Conflicts of interest

Erin Brennand has received an unrestricted educational grant from Cook Medical, grant-in-aid research funding from American Medical Systems and Boston Scientific, and speaker’s fees from Novo Nordisk and Astellas. Sue Ross and Magali Robert have received grant-in-aid research funding from Boston Scientific, Johnson & Johnson, and Cook Medical. Magali Robert is on the Advisory Committee for Cook Myosite. Magnus Murphy and Colin Birch have received preceptorship compensation for teaching by Cook Medical. Selphee Tang has no disclosures.

Funding

Peer review ed funding for the five year follow-up was provided by the Canadian Institutes of Health Research (CIHR MOP 106692). The original trial received peer-reviewed funding from the Alberta Heritage Foundation, and Boston Scientific provided grant-in-aid. None of the funders were involved in the study design, conduct, analysis or writing. Surgical devices were purchased by Calgary Health Region as part of usual care.

Ethics declaration

Both this secondary analysis and the original study were approved by the University of Calgary Conjoint Health Research Ethics Board (Ethics ID 18421).

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Brennand, E.A., Tang, S., Birch, C. et al. Five years after midurethral sling surgery for stress incontinence: obesity continues to have an impact on outcomes. Int Urogynecol J 28, 621–628 (2017). https://doi.org/10.1007/s00192-016-3161-y

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  • DOI: https://doi.org/10.1007/s00192-016-3161-y

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