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The influence of the modifiable life-style factors body mass index and smoking on the outcome of mid-urethral sling procedures for female urinary incontinence

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Abstract

Introduction and hypothesis

The aim of this observational study was to investigate the influence of body mass index (BMI) smoking and age on the cure rate, rate of complications and patient satisfaction with mid-urethral sling (MUS) procedures.

Methods

Pre-, peri- and postoperative (8 weeks and 1 year) data were retrieved from the Swedish National Register for Gynecological Surgery of MUS procedures (retropubic procedures, n = 4,539; transobturator procedures, n =1,769) performed between January 2006 and December 2011. Multiple logistic regression analyses were performed between the outcome variables and BMI and smoking, presented as adjusted odds ratios (adjOR) with 95 % confidence interval (CI).

Results

Subjective 1-year cure rate was 87.4 % for all MUS procedures (88.3 % with the retropubic technique and 85.2 % with the transobturator technique (p = 0.002). Preoperative daily urinary leakage and urgency were more common with increasing BMI, but surgery reduced symptoms in all BMI groups. Lower cure rate was seen in women with a BMI >30 (0.49; CI 0.33–0.73), in diabetics (0.50; CI 0.35–0.74) and women aged > 80 years (0.18; CI 0.06–0.51). Perioperative complications were more common in the retropubic group (4.7 % vs 2.3 % in the transobturator group, p=0.001) and in women with BMI < 25. Smoking did not influence any of the outcome variables.

Conclusions

The overall 1-year cure rate for MUS procedures was 87 %, but was negatively influenced by BMI >30, diabetes and age > 80 years. Perioperative complications were more common with the retropubic procedure than with the transobturator technique, and in women with a BMI < 25. Smoking did not impact on any of the studied outcome variables.

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References

  1. Milsom I, Altman D, Cartwright R, Lapitan MC, Nelson R, Sillén U, Tikkanen K (2013) Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Health Publications, Paris

  2. Morley R, Nethercliffe J (2005) Minimally invasive surgical techniques for stress incontinence surgery. Best Pract Res Clinic Obstet Gynaecol 19(6):925–940. doi:10.1016/j.bpobgyn.2005.08.014

    Article  Google Scholar 

  3. Kuuva N, Nilsson CG (2002) A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 81(1):72–77

    Article  PubMed  Google Scholar 

  4. Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C (2013) Seventeen years’ follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J 24(8):1265–1269. doi:10.1007/s00192-013-2090-2

    Article  CAS  PubMed  Google Scholar 

  5. Hunskaar S (2008) A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn 27(8):749–757

    Article  PubMed  Google Scholar 

  6. Greer WJ, Richter HE, Bartolucci AA, Burgio KL (2008) Obesity and pelvic floor disorders: a systematic review. Obstet Gynecol 112(2 Pt 1):341–349

    Article  PubMed Central  PubMed  Google Scholar 

  7. Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Lee J (2009) Risk factors for trocar injury to the bladder during mid urethral sling procedures. J Urol 182(1):174–179. doi:10.1016/j.juro.2009.02.140

    Article  PubMed  Google Scholar 

  8. Dunivan GC, Connolly A, Jannelli ML, Wells EC, Geller EJ (2009) Body mass index as a risk factor for cystotomy during suprapubic placement of mid-urethral slings. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1127–1131. doi:10.1007/s00192-009-0915-9

    Article  PubMed  Google Scholar 

  9. Lovatsis D, Gupta C, Dean E, Lee F (2003) Tension-free vaginal tape procedure is an ideal treatment for obese patients. Am J Obstet Gynecol 189(6):1601–1604, discussion 1604-1605

    Article  PubMed  Google Scholar 

  10. Killingsworth LB, Wheeler TL 2nd, Burgio KL, Martirosian TE, Redden DT, Richter HE (2009) One-year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1103–1108

    Article  PubMed Central  PubMed  Google Scholar 

  11. Hellberg D, Holmgren C, Lanner L, Nilsson S (2007) The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 18(4):423–429

    Article  PubMed  Google Scholar 

  12. Thomsen T, Villebro N, Moller AM (2010) Interventions for preoperative smoking cessation. Cochrane Database Syst Rev (7):CD002294. doi:10.1002/14651858.CD002294.pub3

  13. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Urogynecol J 21:25–26. doi:10.1007/s00192-00009-00976-00199

    Google Scholar 

  14. Kulseng-Hanssen S (2003) The development of a national database of the results of surgery for urinary incontinence in women. BJOG 110(11):975–982

    Article  PubMed  Google Scholar 

  15. Kulseng-Hanssen S, Borstad E (2003) The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence. BJOG 110(11):983–988

    Article  PubMed  Google Scholar 

  16. Ladfors MB, Lofgren ME, Gabriel B, Olsson JH (2002) Patient accept questionnaires integrated in clinical routine: a study by the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand 81(5):437–442

    Article  PubMed  Google Scholar 

  17. Latthe PM, Singh P, Foon R, Toozs-Hobson P (2010) Two routes of transobturator tape procedures in stress urinary incontinence: a meta-analysis with direct and indirect comparison of randomized trials. BJU Int 106(1):68–76. doi:10.1111/j.1464-410X.2009.09051.x

    Article  PubMed  Google Scholar 

  18. Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, Kraus SR, Chai TC, Lemack GE, Dandreo KJ, Varner RE, Menefee S, Ghetti C, Brubaker L, Nygaard I, Khandwala S, Rozanski TA, Johnson H, Schaffer J, Stoddard AM, Holley RL, Nager CW, Moalli P, Mueller E, Arisco AM, Corton M, Tennstedt S, Chang TD, Gormley EA, Litman HJ (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362(22):2066–2076. doi:10.1056/NEJMoa0912658

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. World Health Organization. BMI classification. 2006 (updated 02/02/2011). Available from: apps.who.int/bmi/index.jsp?introPage=intro_3.html

  20. Dwyer PL, Lee ET, Hay DM (1988) Obesity and urinary incontinence in women. BJOG 95(1):91–96

    Article  CAS  Google Scholar 

  21. Cadish LA, Hacker MR, Dodge LE, Dramitinos P, Hota LS, Elkadry EA (2010) Association of body mass index with hip and thigh pain following transobturator midurethral sling placement. Am J Obstet Gynecol 203(5):508. doi:10.1016/j.ajog.2010.07.023, e501-505

    PubMed  Google Scholar 

  22. Haverkorn RM, Williams BJ, Kubricht WS 3rd, Gomelsky A (2011) Is obesity a risk factor for failure and complications after surgery for incontinence and prolapse in women? J Urol 185(3):987–992

    Article  PubMed  Google Scholar 

  23. Subak LL, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown JS (2005) Weight loss: a novel and effective treatment for urinary incontinence. J Urol 174(1):190–195. doi:10.1097/01.ju.0000162056.30326.83

    Article  PubMed Central  PubMed  Google Scholar 

  24. Lee JK, Dwyer PL, Rosamilia A, Lim YN, Polyakov A, Stav K (2013) Which women develop urgency or urgency urinary incontinence following midurethral slings? Int Urogynecol J 24(1):47–54. doi:10.1007/s00192-012-1844-6

    Article  PubMed  Google Scholar 

  25. Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, Wollum A, Sanman E, Wulf S, Lopez AD, Murray CJ, Gakidou E (2014) Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 311(2):183–192. doi:10.1001/jama.2013.284692

    Article  CAS  PubMed  Google Scholar 

  26. Sadr Azodi O, Lindstrom D, Adami J, Bellocco R, Linder S, Wladis A (2008) Impact of body mass index and tobacco smoking on outcome after open appendicectomy. Br J Surg 95(6):751–757. doi:10.1002/bjs.6079

    Article  CAS  PubMed  Google Scholar 

  27. Lindstrom D, Sundberg-Petersson I, Adami J, Tonnesen H (2010) Disappointment and drop-out rate after being allocated to control group in a smoking cessation trial. Contemp Clin Trials 31(1):22–26. doi:10.1016/j.cct.2009.09.003

    Article  CAS  PubMed  Google Scholar 

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Details of ethics approval

Ethics approval was obtained from the Regional and the National Ethic Review Boards (the Ethics Committee at Sahlgrenska Academy, Gothenburg University, ref no.061-13, 5 June 2013.

Funding

The study was supported by a National LUA/ALF grant no. 11315 and Hjalmar Svenssson’s Research Foundation.

Financial disclaimer/conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, 416 85, Gothenburg, Sweden

    Katja Stenström Bohlin, Corinne Pedroletti & Ian Milsom

  2. Department of Gynecology, Kungsbacka Hospital, Kungsbacka, Sweden

    Maud Ankardal

  3. Department of Mathematics and Mathematical Statistics, Umeå University, Umeå, Sweden

    Håkan Lindkvist

Authors
  1. Katja Stenström Bohlin
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  2. Maud Ankardal
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  3. Corinne Pedroletti
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  4. Håkan Lindkvist
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  5. Ian Milsom
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Correspondence to Ian Milsom.

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Bohlin, K.S., Ankardal, M., Pedroletti, C. et al. The influence of the modifiable life-style factors body mass index and smoking on the outcome of mid-urethral sling procedures for female urinary incontinence. Int Urogynecol J 26, 343–351 (2015). https://doi.org/10.1007/s00192-014-2508-5

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  • DOI: https://doi.org/10.1007/s00192-014-2508-5

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