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The effect of 12-month postoperative weight change on outcomes following midurethral sling for stress urinary incontinence: a secondary analysis of the ESTEEM and TOMUS randomized trials

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Abstract

Introduction and hypothesis

Prior studies demonstrate mixed results on the impact of obesity on the success of midurethral slings (MUS), with little known about how postoperative weight change affects outcomes. We aimed to examine the effect of postoperative weight change on outcomes 12 months after MUS for stress urinary incontinence (SUI).

Methods

This secondary analysis utilized data from two multicenter randomized trials of women undergoing MUS placement. Subjects were categorized into cohorts based on change in body weight at 12 months postoperatively: weight gain (≥5% increase); weight loss (≥5% decrease), and weight stable (<5% change). The primary outcome was SUI cure (no SUI episodes in a 3-day bladder diary). Patients with mixed urinary incontinence (MUI) were analyzed for changes in daily average urge incontinence (UUI) episodes in a 3-day diary. Penalized logistic regression assessed the impact of demographic and perioperative variables on the primary outcome.

Results

Of the 918 women included, 635 (70%) were weight stable, 144 (15%) had weight gain, and 139 (15%) had weight loss. Patients in the weight loss cohort had a higher smoking rate and a higher baseline body mass index (SD 0.29, 2.7 respectively). All cohorts experienced high SUI cure rates ranging from 77 to 81%, with no significant difference in SUI cure between cohorts (p = 0.607). Of 372 subjects with MUI, the weight loss cohort had significantly greater improvement in UUI episodes.

Conclusions

Weight change at 12 months postoperatively did not significantly alter efficacy of MUS for treatment of SUI. Patients with MUI who lost ≥5% body weight had significantly greater improvement in UUI episodes.

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Data Availability

This is a secondary analysis of publically available data, discussed in methods.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, MedStar Georgetown Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA

    Feven W. Getaneh, Cheryl B. Iglesia & Alexis A. Dieter

  2. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA

    Nancy Ringel

  3. Medstar Health Research Institute, Washington, DC, USA

    Paul Kolm

Authors
  1. Feven W. Getaneh
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  2. Nancy Ringel
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  3. Paul Kolm
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  4. Cheryl B. Iglesia
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  5. Alexis A. Dieter
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Contributions

F.W. Getaneh: protocol development, data collection and analysis, manuscript writing/editing; N. Ringel: project development, manuscript writing; P. Kolm: management data analysis, manuscript writing; C.B. Iglesia: protocol development, manuscript writing/editing; A. Dieter: protocol development, data collection and analysis, manuscript writing/editing.

Corresponding author

Correspondence to Feven W. Getaneh.

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Conflicts of interest

Cheryl Iglesia: acceptance of paid travel expenses through the Society of Gynecological Surgeons, OBGYN Management, and the Patty Brisben Foundation. Reports holding a position of influence within the NIH NICHD PFDN network, US FDA Special Government Employee, and the Urogynecology journal editorial board.

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Getaneh, F.W., Ringel, N., Kolm, P. et al. The effect of 12-month postoperative weight change on outcomes following midurethral sling for stress urinary incontinence: a secondary analysis of the ESTEEM and TOMUS randomized trials. Int Urogynecol J 34, 2809–2816 (2023). https://doi.org/10.1007/s00192-023-05654-7

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  • DOI: https://doi.org/10.1007/s00192-023-05654-7

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