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Erschienen in: International Urogynecology Journal 2/2016

01.02.2016 | Original Article

Incontinence surgery in obese women: comparative analysis of short- and long-term outcomes with a transobturator sling

verfasst von: Inês Pereira, Alexandre Valentim-Lourenço, Catarina Castro, Inês Martins, Alexandra Henriques, Ana Luísa Ribeirinho

Erschienen in: International Urogynecology Journal | Ausgabe 2/2016

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Abstract

Introduction and hypothesis

Midurethral slings (MUS) are still discussed in complex incontinence situations, such as obesity, lacking sustained efficacy validation in this particular sub-population. We hypothesized that the outcomes of a transobturator MUS, such as TVT-O, do not differ according to body mass index (BMI) over a 4-year period.

Methods

We conducted a retrospective analysis of 281 women who underwent TVT-O at our institution, between 2004 and 2012. Patients were stratified into obese (BMI ≥ 30 kg/m2) or non-obese (BMI < 30 kg/m2). We compared preoperative and postoperative parameters, including objective cure (negative stress test), complications, and quality of life scores. Data were collected at 0, 6, 12, 24, and 48 months. We used Fisher’s exact test for categorical variables and Student’s t test or the Mann–Whitney U test for continuous variables.

Results

Baseline characteristics of the obese (n = 122) and non-obese groups (n = 159) were similar. We found no significant differences between groups in terms of objective cure rates at all follow-up evaluations, with 95.8 % and 95 % at 48 months in the non-obese and obese groups respectively. There were no significant differences in the cumulative complication rates of both groups. Quality of life assessment also showed no significant differences between groups at all follow-up visits. At 48 months our follow-up rate was 59 % (n = 96) and 60.4 % (n = 72) in the non-obese and obese group respectively (p = 0.9).

Conclusions

The TVT-O procedure is effective and safe in the long term for stress incontinence treatment, regardless of BMI.
Literatur
1.
Zurück zum Zitat Hunskaar S, Burgio K, Diokno A et al (2003) Epidemiology and natural history of urinary incontinence in women. Urology 62 [Suppl 1]:16–23CrossRefPubMed Hunskaar S, Burgio K, Diokno A et al (2003) Epidemiology and natural history of urinary incontinence in women. Urology 62 [Suppl 1]:16–23CrossRefPubMed
2.
Zurück zum Zitat 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 27:749–757CrossRefPubMed 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 27:749–757CrossRefPubMed
3.
Zurück zum Zitat Mommsen S, Foldspang A (1994) Body mass index and adult female urinary incontinence. World J Urol 12:319–322CrossRefPubMed Mommsen S, Foldspang A (1994) Body mass index and adult female urinary incontinence. World J Urol 12:319–322CrossRefPubMed
5.
Zurück zum Zitat Flegal KM, Carroll MD, Kit BK et al (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307:491–497CrossRefPubMed Flegal KM, Carroll MD, Kit BK et al (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307:491–497CrossRefPubMed
6.
Zurück zum Zitat Global Health Observatory (GHO) (2013) Obesity 2008. World Health Organization Global Health Observatory (GHO) (2013) Obesity 2008. World Health Organization
7.
Zurück zum Zitat Ulmsten U, Petros P (1995) Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 29(1):75–82CrossRefPubMed Ulmsten U, Petros P (1995) Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 29(1):75–82CrossRefPubMed
8.
Zurück zum Zitat Ward KL, Hilton P, UK and Ireland TVT Trial Group (2008) A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG 115:226–233CrossRefPubMed Ward KL, Hilton P, UK and Ireland TVT Trial Group (2008) A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG 115:226–233CrossRefPubMed
9.
Zurück zum Zitat Novara G, Artibani W, Barber MD et al (2010) Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol 58:218–238CrossRefPubMed Novara G, Artibani W, Barber MD et al (2010) Updated systematic review and meta-analysis of the comparative data on colposuspensions, pubovaginal slings and midurethral tapes in the surgical treatment of female stress urinary incontinence. Eur Urol 58:218–238CrossRefPubMed
10.
Zurück zum Zitat Haverkorn R, Williams B, Kubricht W III et al (2011) Is obesity a risk factor for failure and complications after surgery for incontinence and prolapse in women? J Urol 185:987–992CrossRefPubMed Haverkorn R, Williams B, Kubricht W III et al (2011) Is obesity a risk factor for failure and complications after surgery for incontinence and prolapse in women? J Urol 185:987–992CrossRefPubMed
11.
Zurück zum Zitat Abdel-Fattah M, Familusi A, Ramsay I et al (2010) Preoperative determinants for failure of transobturator tapes in the management of female urodynamic stress incontinence. Int J Gynaecol Obstet 110:18–22CrossRefPubMed Abdel-Fattah M, Familusi A, Ramsay I et al (2010) Preoperative determinants for failure of transobturator tapes in the management of female urodynamic stress incontinence. Int J Gynaecol Obstet 110:18–22CrossRefPubMed
12.
Zurück zum Zitat Hellberg D, Holmgren C, Lanner L et al (2007) The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. Int Urogynecol J 18:423–429CrossRef Hellberg D, Holmgren C, Lanner L et al (2007) The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. Int Urogynecol J 18:423–429CrossRef
13.
Zurück zum Zitat Abdel-Fattah M, Ramsay I, Pringle S et al (2010) Randomized prospective single-blinded study comparing ‘inside-out’ versus ‘outside-in’ transobturator tapes in the management of urodynamic stress incontinence: 1 year outcomes. BJOG 117:870–878CrossRefPubMed Abdel-Fattah M, Ramsay I, Pringle S et al (2010) Randomized prospective single-blinded study comparing ‘inside-out’ versus ‘outside-in’ transobturator tapes in the management of urodynamic stress incontinence: 1 year outcomes. BJOG 117:870–878CrossRefPubMed
14.
Zurück zum Zitat Heinonen P, Ala-Nissila S, Raty R et al (2013) Objective cure rates and patient satisfaction after the transobturator tape procedure during 6.5 year follow-up. J Minim Invasive Gynecol 20:73–78CrossRefPubMed Heinonen P, Ala-Nissila S, Raty R et al (2013) Objective cure rates and patient satisfaction after the transobturator tape procedure during 6.5 year follow-up. J Minim Invasive Gynecol 20:73–78CrossRefPubMed
15.
Zurück zum Zitat Liu PE, Su CH, Lau HH et al (2011) Outcome of tension-free obturator tape procedures in obese and overweight women. Int Urogynecol J 22:259–263CrossRefPubMed Liu PE, Su CH, Lau HH et al (2011) Outcome of tension-free obturator tape procedures in obese and overweight women. Int Urogynecol J 22:259–263CrossRefPubMed
16.
Zurück zum Zitat Killingsworth LB, Wheeler TL 2nd, Burgio KL et al (2009) One year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women. Int Urogynecol J Pelvic Floor Dysfunct 20:1103–1108PubMedCentralCrossRefPubMed Killingsworth LB, Wheeler TL 2nd, Burgio KL et al (2009) One year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women. Int Urogynecol J Pelvic Floor Dysfunct 20:1103–1108PubMedCentralCrossRefPubMed
17.
Zurück zum Zitat Mukherjee K, Constantine G (2001) Urinary stress incontinence in obese women: tension-free vaginal tape is the answer. BJU Int 88:881–883CrossRefPubMed Mukherjee K, Constantine G (2001) Urinary stress incontinence in obese women: tension-free vaginal tape is the answer. BJU Int 88:881–883CrossRefPubMed
18.
Zurück zum Zitat Esin S, Salman MC, Ozyuncu O et al (2011) Surgical outcome of transobturator tape procedure in obese and non-obese women. J Obstet Gynaecol 31:645–649CrossRefPubMed Esin S, Salman MC, Ozyuncu O et al (2011) Surgical outcome of transobturator tape procedure in obese and non-obese women. J Obstet Gynaecol 31:645–649CrossRefPubMed
19.
Zurück zum Zitat Tchey DU, Kim WT, Kim YJ et al (2010) Influence of obesity on short-term surgical outcome of the transobturator tape procedure in patients with stress urinary incontinence. Int Neurourol 14:13–19CrossRef Tchey DU, Kim WT, Kim YJ et al (2010) Influence of obesity on short-term surgical outcome of the transobturator tape procedure in patients with stress urinary incontinence. Int Neurourol 14:13–19CrossRef
20.
Zurück zum Zitat Rafii A, Darai E, Haab F et al (2003) Body mass index and outcome of tension-free vaginal tape. Eur Urol 43:288–292CrossRefPubMed Rafii A, Darai E, Haab F et al (2003) Body mass index and outcome of tension-free vaginal tape. Eur Urol 43:288–292CrossRefPubMed
21.
Zurück zum Zitat Ku JH, Oh JG, Shin JW et al (2006) Outcome of mid-urethral sling procedures in Korean women with stress urinary incontinence according to body mass index. Int J Urol 13:279–284 Ku JH, Oh JG, Shin JW et al (2006) Outcome of mid-urethral sling procedures in Korean women with stress urinary incontinence according to body mass index. Int J Urol 13:279–284
22.
Zurück zum Zitat Brennand EA, Tang S, Williamson T et al (2014) Twelve-month outcomes following midurethral sling procedures for stress incontinence: impact of obesity. BJOG. doi:10.1111/1471-0528.13132 Brennand EA, Tang S, Williamson T et al (2014) Twelve-month outcomes following midurethral sling procedures for stress incontinence: impact of obesity. BJOG. doi:10.​1111/​1471-0528.​13132
23.
Zurück zum Zitat Hwang IS, Yu JH, Chung JY et al (2012) One-year outcomes of mid-urethral procedures for stress urinary incontinence according to body mass index. Korean J Urol 53:171–177PubMedCentralCrossRefPubMed Hwang IS, Yu JH, Chung JY et al (2012) One-year outcomes of mid-urethral procedures for stress urinary incontinence according to body mass index. Korean J Urol 53:171–177PubMedCentralCrossRefPubMed
24.
Zurück zum Zitat Jeong SJ, Lee HS, Lee JK et al (2014) The long-term influence of body mass index on the success rate of mid-urethral sling surgery among women with stress urinary incontinence or stress-predominant mixed incontinence: comparisons between retropubic and transobturator approaches. PLoS One 9(11):e113517. doi:10.1371/journal.pone.0113517 PubMedCentralCrossRefPubMed Jeong SJ, Lee HS, Lee JK et al (2014) The long-term influence of body mass index on the success rate of mid-urethral sling surgery among women with stress urinary incontinence or stress-predominant mixed incontinence: comparisons between retropubic and transobturator approaches. PLoS One 9(11):e113517. doi:10.​1371/​journal.​pone.​0113517 PubMedCentralCrossRefPubMed
25.
Zurück zum Zitat WHO (2000) Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. World Health Organization, Geneva WHO (2000) Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. WHO Technical Report Series 894. World Health Organization, Geneva
26.
Zurück zum Zitat Tamanini JT, D’Ancona CA, Botega NJ et al (2003) Validation of the Portuguese version of the King’s Health Questionnaire for urinary incontinent women. Rev Saude Publica 37(2):203–211CrossRefPubMed Tamanini JT, D’Ancona CA, Botega NJ et al (2003) Validation of the Portuguese version of the King’s Health Questionnaire for urinary incontinent women. Rev Saude Publica 37(2):203–211CrossRefPubMed
27.
Zurück zum Zitat Ghoniem G, Stanford E, Kenton K et al (2008) Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J Pelvic Floor Dysfunct 19:5–33PubMedCentralCrossRefPubMed Ghoniem G, Stanford E, Kenton K et al (2008) Evaluation and outcome measures in the treatment of female urinary stress incontinence: International Urogynecological Association (IUGA) guidelines for research and clinical practice. Int Urogynecol J Pelvic Floor Dysfunct 19:5–33PubMedCentralCrossRefPubMed
28.
Zurück zum Zitat Noblett KL, Jensen JK, Ostergard DR et al (1997) The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct 8:323–326CrossRefPubMed Noblett KL, Jensen JK, Ostergard DR et al (1997) The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct 8:323–326CrossRefPubMed
29.
Zurück zum Zitat Bullock TL, Ghoneim G, Klutke CG et al (2006) Advances in female stress urinary incontinence: midurethral slings. BJU 98 [Suppl 1]:32–40CrossRef Bullock TL, Ghoneim G, Klutke CG et al (2006) Advances in female stress urinary incontinence: midurethral slings. BJU 98 [Suppl 1]:32–40CrossRef
30.
Zurück zum Zitat De Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724–730 De Leval J (2003) Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur Urol 44:724–730
31.
Zurück zum Zitat Ogah J, Cody JD, Rogerson L (2009) Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 4:CD006375PubMed Ogah J, Cody JD, Rogerson L (2009) Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database Syst Rev 4:CD006375PubMed
Metadaten
Titel
Incontinence surgery in obese women: comparative analysis of short- and long-term outcomes with a transobturator sling
verfasst von
Inês Pereira
Alexandre Valentim-Lourenço
Catarina Castro
Inês Martins
Alexandra Henriques
Ana Luísa Ribeirinho
Publikationsdatum
01.02.2016
Verlag
Springer London
Erschienen in
International Urogynecology Journal / Ausgabe 2/2016
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-015-2820-8

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