The impact of obesity on outcomes and complications after top‐down retropubic midurethral sling

Karaman, Umar; Campbell, Kevin J.; Frilot, Clifton; Gomelsky, Alex

doi:10.1002/nau.23098

Cited by 10 publications

(4 citation statements)

References 30 publications

(43 reference statements)

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“…Additionally, they reported 68.8% (n = 27) of overall complications in obese patients and 72% (n = 98) in nonobese patients. 12 These findings are similar to the Karamán et al 33 study where a cohort of 622 was evaluated and no differences for complications between obese and nonobese groups were found. Also, Weltz et al 32 meta-analyzed data to found more bladder perforations in obese women, but no differences for urinary retention or sling excision.…”

Section: Discussionsupporting

confidence: 85%

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta‐analysis

Barco‐Castillo

Zuluaga

Serrano

et al. 2020

Neurourology and Urodynamics

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Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. Materials and Methods: A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. Results: A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m 2) and nonobese (<30 kg/m 2). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. Conclusions: This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.

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Section: Discussionsupporting

confidence: 85%

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta‐analysis

Barco‐Castillo

Zuluaga

Serrano

et al. 2020

Neurourology and Urodynamics

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“…1 However, studies investigating whether obesity is a risk factor for failure after MUS surgery show contradictory results. [167][168][169][170][171] Both the present study and the Norwegian study found that a BMI over 30 correlated with significantly higher odds of patient reported SUI. Another risk factor for persisting SUI symptoms, found in both our and the Norwegian study, was repeat surgery for SUI.…”

Section: Study IIIsupporting

confidence: 57%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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Background and aimsThe life-time risk for a woman to undergo pelvic floor reconstructive surgery due to prolapse or incontinence is 20% and the high risk for recurrence after prolapse surgery is a major challenge. Surgical reconstruction of the perineal body is commonly performed, although studies assessing results of this procedure are scarce. Mid-urethral sling surgery has a cure rate of 80%, but whether the sling endures a subsequent delivery is largely unknown. In this thesis we aimed to investigate whether the choice of suture material has an impact on vaginal wall prolapse repair; whether cervical amputation results in similar cure rates in comparison to vaginal hysterectomy in women with uterine prolapse; if a subsequent delivery jeopardizes results from incontinence surgery; if physiotherapy and surgical treatment is equally effective in women with symptoms related to a poorly healed second-degree perineal tear. Methods and main resultsStudy I and II are both register-based cohort studies based on data from the Swedish National Quality Register for Gynecological Surgery (GynOp). In Study I, 731 women who underwent primary anterior colporrhaphy and 384 women who underwent primary posterior colporrhaphy were included. We found a significantly lower rate of women reporting vaginal bulging symptoms one year after anterior colporrhaphy if a slowly absorbable monofilament suture was used compared to a more rapidly absorbable multifilament suture, 22% vs 30% (aOR 1.6, 95% CI 1.1-2.3). There was no difference between the suture groups in the posterior colporrhaphy cohort. In Study II, women with uterine prolapse who had undergone either cervical amputation (n=1979) or vaginal hysterectomy (n=1195) were analyzed. There were no differences between the two groups regarding neither symptom relief nor patient satisfaction at one year after surgery. Vaginal hysterectomy was associated with a higher rate of severe complications compared to cervical amputation, 1.9 % vs 0.2 % (p < 0.001).Study III is a cross-sectional, survey-based study. National registers were used to identify women with a delivery subsequent to a mid-urethral sling procedure (n=207) and a matched control-group including women without childbirth after a mid-urethral sling procedure (n=521). Validated questionnaires investigating urinary symptoms were mailed to the study participants. Patient reported stress urinary incontinence was present in 22% of the women with a delivery after a mid-urethral sling procedure and in 17% of the women in the control group (aOR 1.2, 95% CI 0.7-2.0). Vaginal childbirth after mid-urethral sling surgery did not increase the risk of stress urinary incontinence compared to cesarean delivery. Study IV is a randomized controlled trial where 70 women with a poorly healed second degree perineal tear, minimum six months post-partum, were randomized to either surgery or tutored pelvic floor muscle therapy. In an intention-to-treat analysis with worst case outcome imputation, treatment success at 6 months followup was significantly...

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“…In a randomised controlled trial of SUI women who underwent mid‐urethral sling procedures, obese patients experienced lower rates of amelioration compared with non‐obese patients . In contrast, another group analysed the effectiveness of a top‐down retropubic polypropylene mid‐urethral sling on SUI, showing no BMI‐associated differences in success rate or improvement in quality‐of‐life. The mechanism responsible for the discrepancy remains unclear and the use of varying interventions for the treatment of SUI may contribute to these conflicting findings.…”

Section: Discussionmentioning

confidence: 89%

Comparing the effect of electroacupuncture treatment on obese and non‐obese women with stress urinary incontinence or stress‐predominant mixed urinary incontinence: A secondary analysis of two randomised controlled trials

Wang

Liu

et al. 2019

Int J Clin Pract

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Objective To explore whether obesity patients with a body mass index (BMI) of ≥25 kg/m2 who suffer from stress urinary incontinence (SUI) or stress‐predominant mixed urinary incontinence (S‐MUI) show less improvement in urinary incontinence (UI) symptoms after electroacupuncture (EA) treatment compared with non‐obese counterparts. Methods This study was a secondary analysis of existing data. About 252 SUI patients and 250 S‐MUI patients treated with the same EA regimen were assigned to one of the two groups: the obesity group for BMI ≥25 kg/m2 and the non‐obesity group for BMI <25 kg/ m2. The primary outcome was the proportion of treatment responders, defined as patients exhibiting a ≥50% reduction in 72‐hours incontinence episode frequency, as measured by a 72‐hours bladder diary at week 6 compared with baseline. Results Of the 1004 randomised women, 129 obese women (86 SUI and 43 S‐MUI) and 255 non‐obese women (166 SUI and 89 S‐MUI) treated with EA were included in a secondary analysis. The primary outcome was that 58.3% (74/127) of patients in the obesity group and 60.7% (150/247) of patients in the non‐obesity group (difference 0.55%; 95% confidence interval, −10.01 to 11.11; P = .919) responded to treatment. Conclusion This study suggests that EA treatment may safely improve UI symptoms in both obese and non‐obese patients, regardless of BMI category. Additionally, obesity status may not affect the efficacy of EA treatment on SUI or S‐MUI among Chinese women.

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The impact of obesity on outcomes and complications after top‐down retropubic midurethral sling

Abstract: Obese women have similar success rates and significant improvement in QoL as non-obese women after RPM. Obesity alone does not appear to be a risk factor for additional complications during sling surgery and obese women may have earlier return to normal voiding after surgery.

Cited by 10 publications

References 30 publications

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta‐analysis

Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta‐analysis

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Comparing the effect of electroacupuncture treatment on obese and non‐obese women with stress urinary incontinence or stress‐predominant mixed urinary incontinence: A secondary analysis of two randomised controlled trials

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