Influence of body mass index on short-term subjective improvement and risk of reoperation after mid-urethral sling surgery
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Introduction and hypothesis
The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery.
Data were retrieved from the national Danish Urogynaecological Database, including women with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3 months postoperatively. A reoperation was defined as any new surgical procedure for stress urinary incontinence performed within the study period.
During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence Questionnaire (ICI-Q) forms. 42.4% had a BMI < 25, 34.6% had BMI 25–30, 16.9% had BMI 30–35, and 6.0% BMI >35. The subjective improvement after surgery was high in all BMI categories and there were no differences between the categories. The overall cumulative hazard proportion at 2 years of follow-up was 1.9% (CI 95%: 1.6–2.3) and after 5 years 2.4% (CI 95%: 2.0–2.9). Adjusted for age, smoking, and use of alcohol, the cumulative hazard proportion after 2 years of follow-up was 3.2% (CI 95%: 1.6–6.2) for women with BMI >35 and after 5 years 4.0% (CI 95%: 2.0–7.7), which was the highest proportion of reoperation in the study. The crude hazard ratio was 1.84 (CI 95%: 0.89–3.83) women with BMI >35 and the adjusted hazard ratio was 1.94 (CI 95%: 0.92–4.09).
We found high subjective improvement after the first-time surgery unrelated to BMI. Women with a BMI over 35 had the highest proportion of reoperations, although this was not statistically significant.
KeywordsUrinary incontinence Sling surgery Body mass index Patient reported outcomes Subjective improvement Reoperation Mesh
Body mass index
The National Danish Urogynaecological Database
The International Consultation on Incontinence
International Consultation on Incontinence Questionnaire
International Consultation on Incontinence Questionnaire Short Form
Danish National Patient Registry
Patient Global Impression of Improvement
Patient Reported Outcome Measures
Public Health Notification
Stress urinary incontinence
- US FDA
United States Food and Drug Administration
Visual analogue scales
World Health Organization
The study was supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation.
Compliance with ethical standards
Conflicts of interest
Dr Weltz had travel expenses paid for by Astellas for EUGA Congress 2016. Dr Guldberg has accepted grants from Astellas and Pierre Fabre, Dr Lose has accepted payment for research from Astellas and worked as a consultant for Contura. The remaining authors claim that they have no conflicts of interest.
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