Body Mass Index and Outcome of Tension-Free Vaginal Tape
Introduction
In France, the prevalence of obesity, defined by a body mass index (BMI) above 30 kg/m2, is 8–10% of the adult population [1]. Between 1980 and 1991, there was a slight increase in prevalence of obesity (from 6.3% to 7.0%) and of overweight (from 26.8% to 27.5%) in French women [2]. The prevalence of obesity is similar to those reported in other European countries, such as Sweden and The Netherlands, and lower than in the UK, USA and Canada. Obesity is described as a risk factor for genuine stress incontinence and detrusor instability [3], [4], [5]. Some authors have described an increase of intra-abdominal pressure in obese patients [6]. This phenomenon possibly can stress the pelvic floor, causing nerve and muscular injury which might lead to a higher prevalence of SUI. The surgical treatment of SUI is frequently perceived to be less effective in obese females, increased failure rates among obese women undergoing needle suspension and retropubic procedures have been reported [7]. Tension-free vaginal tape (TVT) is a popular operation for the surgical treatment of stress urinary incontinence. This technique is now considered an alternative to classic surgical methods because it is easy to learn, has a low incidence of peri-operative and post-operative complications and a high short-term success rate [8].
Only two studies have evaluated the effectiveness of TVT in obese women. Mukherjee and Constantine [9] found that the BMI had no incidence on the subjective cure rate, even if obese women had significantly worse bladder-related “Quality of Life” scores. Chung and Chung [10] evaluated retrospectively 91 patients who underwent a TVT procedure; 60% of the patients in their study were obese women. They reported a 100% cure rate after the TVT procedure regardless of the patients’ BMI. In these two studies there were no differences regarding the procedure or the post-operative outcomes between the obese and normal weighted patients. However, in those studies there was no information on the rate of de novo urgency and on the rate of voiding disorders after the TVT procedure in obese patients. The aim of our study was to assess the feasibility, and the peri-operative and post-operative morbidity of TVT in obese patients and to assess the rates of de novo urgency and voiding disorders induced by this procedure in obese and overweight patients.
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Materials and methods
From June 1998 to February 2001, 187 consecutive patients with proven urinary incontinence underwent the tension-free vaginal tape procedure in the gynecology department at our institution. Patients with a neurological disorder or bladder instability were excluded from the study. The severity of urinary incontinence was classified using the Ingelman–Sundberg scale, including grade I—urinary incontinence when coughing or sneezing, grade II—urinary incontinence when running or picking up objects
Characteristics of the patients, indication and associated procedures
The characteristics of patients undergoing a tension-free vaginal tape according to the BMI are given in Table 1. A difference in the mean body mass index was found between the groups (p<0.0001). The mean BMI was significantly different between the three groups. No difference in age, menopausal status, rate of previous SUI surgery, pre-operative VAS, use of pads was noted according to the groups.
The indications for surgery in each group are given in Table 1. No significant difference in
Discussion
The present study has confirmed the feasibility, the safety and the efficacy of tension-free vaginal tape for obese and overweight women.
Surgical treatment of genuine stress incontinence is technically more difficult in obese patients especially when this is performed as an abdominal procedure; there is, in this group, an increased risk of intra-operative and post-operative complications [3], [14]. In our study the TVT procedure could be performed in overweight and obese patients without
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