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Impact of severe obesity on long-term success and complications of the retropubic midurethral sling

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Abstract

Introduction and hypothesis

With conflicting evidence in the literature, we hypothesised that the long-term subjective outcomes of the retropubic midurethral sling (MUS) are the same in the severely obese and non-obese populations.

Methods

A retrospective matched cohort study was performed on women with a BMI ≥ 35 and < 30 who had a retropubic MUS placed between 2010 and 2015 using telephone questionnaires. The primary outcome was the success rate of surgery defined by the Urogenital Distress Inventory Short Form (UDI-6) stress subscale. Statistical analysis was performed to test for associations between primary and secondary outcomes across the two groups.

Results

Seventy-eight severely obese (SOG) and 74 non-obese (NOG) were recruited. At a median time from surgery of 3.8 years the success rate was 47.4% in the SOG compared to 64.9% in the NOG (p = 0.03). There was a 22% reduction in the odds of success with every 5 unit increase in BMI (p = 0.03). There were higher rates of mixed urinary incontinence preoperatively (60.3% vs. 37.8%, p = 0.006) and persistent urinary urge incontinence postoperatively (48.7% vs. 32.4% p = 0.04) in the severely obese. Lower PGI-I scores were obtained in the severely obese group indicating less improvement in symptoms from surgery. There was no difference in complication rates between the groups.

Conclusion

Long-term subjective outcomes from the retropubic MUS are lower in severely obese women than in non-obese women with no difference in complication rates. High satisfaction and recommendation rates were found in both groups.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Middlemore Hospital, Auckland, New Zealand

    Nicola Dykes & Lynsey Hayward

  2. North Shore Hospital, Auckland, New Zealand

    Nicola Dykes

  3. Research and Evaluation Office, Ko Awatea, Middlemore Hospital, Auckland, New Zealand

    Christin Coomarasamy

Authors
  1. Nicola Dykes
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  2. Lynsey Hayward
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  3. Christin Coomarasamy
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Contributions

N Dykes: Protocol development, data collection and management, data analysis, manuscript writing.

L Hayward: Protocol development, manuscript editing.

C Coomarasamy: Data analysis.

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Correspondence to Nicola Dykes.

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Dykes, N., Hayward, L. & Coomarasamy, C. Impact of severe obesity on long-term success and complications of the retropubic midurethral sling. Int Urogynecol J 32, 57–63 (2021). https://doi.org/10.1007/s00192-020-04414-1

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  • DOI: https://doi.org/10.1007/s00192-020-04414-1

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