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Twelve‐month outcomes following midurethral sling procedures for stress incontinence: impact of obesity
Author(s) -
Brennand EA,
Tang S,
Williamson T,
Birch C,
Murphy M,
Robert M,
Ross S
Publication year - 2015
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13132
Subject(s) - medicine , urinary incontinence , confidence interval , body mass index , population , surgery , sling (weapon) , environmental health
Objective To evaluate impact of body mass index ( BMI ) ≥30 on objective and subjective cure rates 12 months after midurethral sling surgery. Design Secondary analysis. Setting Three hospitals in Calgary, Canada, 2005–07. Population A total of 182 women enrolled in a randomised control trial of tension‐free vaginal tape versus transobturator tape. Methods Women were classified as obese or nonobese from height and weight on day of surgery. Women underwent postoperative standardised pad tests, self‐reporting of urinary incontinence, and quality of life scores. Categorical data compared with chi‐square or Fisher's exact, continuous data compared with Mann–Whitney U test. Main outcome measures Primary outcome was objective cure, defined as <1 g urine loss on postoperative 1‐hour pad test. Secondary outcomes were subjective cure of incontinence (no stress incontinence in previous 7 days), presence of urinary urgency in previous 7 days, Urogenital Distress Inventory ( UDI ‐6) scores, Incontinence Impact Questionnaire ( IIQ ‐7) scores, and surgical complication rates. Results Objective cure differed, with 85.6% of nonobese women leaking <1 g on 1‐hour pad test, versus 67.8% of obese women ( P = 0.006, risk difference [ RD ] 17.8%, 95% confidence interval [95% CI ] 4.2–31.4%). Subjective cure was 85.8% for nonobese women versus 70.7% for obese women ( P = 0.016, RD 15.1%, 95% CI 1.9–28.4%). For both groups, improvement was seen for postoperative UDI ‐6 (median −33.3 [−44.4 to −22.2] and −27.2 [−44.4 to −16.7]) and IIQ ‐7 scores (median −26.2 [−45.2 to −14.3] and −23.8 [−42.9 to −14.3]). No differences existed in rates of operative complications between the two groups. Conclusion Twelve months after midurethral sling surgery, obese women experience lower rates of cure than those who are nonobese.