INFLUENCE OF OBESITY ON SURGICAL OUTCOME OF THE TRANSOBTURATOR TAPE FOR STRESS URINARY INCONTINENCE
Stress urinary incontinence is the most prevalent disease in middle-aged women. Obesity is one of the most important risk factors for the development of urinary incontinence. There are limited data available concerning safety, efficacy and outcome of TOT procedure in obese females. The aim of our study was to evaluate the influence of obesity on clinical aspects, quality of life (QoL) and outcomes in patients with stress urinary incontinence (SUI) who underwent transobturator tape (TOT) surgery.
Materials and Methods
We evaluated 30 patients who underwent TOT in our hospital between january 2008 and july 2014, stratified by BMI in normal (< 25) and obese (≥ 25) group. We compared pre and postoperative evaluations, including subjective and objective outcome of TOT, complications, and QoL. They all underwent conservative therapy, including biofeedback, electrical stimulation for three months before surgery. All patients were urodinamically diagnosed with SUI; patients with mixed symptoms were escluded. Patients were escluded if PVR execeeded 100ml, or had detrusor overactivity or cystocele. We performed 14 TOT using “Monarc “, and 16 using TVTO by Gynecare. The procedures were performed with patient in high lithotomy position and under spinal anesthesia. All receveid antibiotic therapy, and were instructed to avoid exercise, sexual intercourse for 4-6 weeks postoperatively. Intraoperative events included bloodloss and time of implantation. In postoperative evaluation we utilized ICIQ-SF, and pads used, not urodinamics. Cure was defined as no leakage (dry), improvement was defined as a reduction of 50% or more in the use of pads. Outcome measures reported include continence status, pad use, urinary urgency, PVR.
30 female patients with SUI underwent TOT. According to their body mass index, 14 were in group A (normal weight< 25Kg/m2) with a mean age of 60.35 (46-71) and 16 in group B (over weight ≥ 25Kg/m2 ) with a mean age 59.5 (48-75). The median BMI was 21.94 (20.56-23.01) in group A, and 29.59 (27.39-32.02) in group B. The patients were followed up between 4 and 48 months with a median follow up of 30 months. No significant differences were evaluated in time of surgical procedure between the groups: 39.9 min (28-70min) in group A and 39.5 (28-75) in group B. After surgery the used pads/day significantly reduced from baseline 4.3 (3-5) to 0 (0-2), and no significant differences were reported between the two groups. Questionaries on QoL (ICIQ-SF) showed no significant differences between groups. No intraoperative complication were reported. We described de novo urge in 2 women ( 1 for group) and 1 temporary retention in group B.
This study showed that TOT procedure was safe and effective for treating SUI regardless of BMI. The quality of life and use of pads/die were similarly improved in two groups, and number of complications was not influenced by BMI. Although obesity is a well estabilished risk factor for the development of SUI, does not influence outcome of TOT procedure. A great number of reports shows a good success rate of TVT surgery in obese patients, and shows that obesity does not influence the outcome. In other studies using transobturator tape procedures no association between BMI and surgical outcome was found. (2,3) In our study we found the same results in few cases. In our opinion we needed long term follow up and more cases to evaluate the exact influence of obesity in TOT outcomes.
Stress urinary incontinence is the most prevalent disease in middle-aged women. Many studies showed that TOT procedure is safe and effective for treating SUI. Obesity is one of the most important risk factors for the development of urinary incontinence. There are limited data and few studies available concerning safety, efficacy and outcome of TOT procedure in obese females. In this study we showed that TOT procedure is safe and effective; it can be applied even in obese SUI patients with high expetations, although long term follow up and a large number of patients are necessary. The recurrence rate, complications, and satisfaction of patients were not influenced by BMI.
1) Lawrence JM et al. Diabetes Care 2007, 30:2536-41
2) Frohme et al. BMC Urology 2014, 14:20
3) Liu Pe et al.Int. Urogynecol J 2011, 22:259-63