Do severe obese patients with stress urinary incontinence benefit from transobturator tape procedure? 3-year surgical outcome

Abstract

Introduction:We evaluate the impact of severe obesity on surgical outcomes of the transobturator tape (TOT) procedure in patients with stress urinary incontinence (SUI). Methods: In total, 32 women with severe obesity (body mass index [BMI] >35 kg/m 2 ) were included in the study. All patients were preoperatively evaluated with history, pelvic examination, ultrasonography, and cough stress test. All patients completed the International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) preoperatively and at the postoperative followup. Cure of incontinence was defined as being completely dry after surgery. Cure was assessed subjectively and objectively. Subjective improvement defined as an International Consultation on Incontinence Questionnaire-Short form (ICIQ-SF) score ≤12 and satisfaction with surgery. Failure was defined as having no change or worsening of urinary incontinence after surgery. Postoperative patient satisfaction was assessed using a visual analog scale. Results: The mean follow-up time and mean BMI were 40.9 ± 20.9 months and 38 ± 3 kg/m 2 , respectively. According to preoperative ICIQ-SF questionnaire scores, 20 patients (62.5%) had severe and 12 patients (37.5 %) had very severe urinary incontinence symptoms. No patient had slight or moderate symptoms. None of the patients experienced worsening symptoms after surgery. Objective cure, subjective cure, subjective improvement and patient satisfaction rates were 81.2%, 46.8%, 37.5%, and 84.3% respectively. Our overall complication rate was 9.3%. None of the patients experienced intraoperative complications. Conclusion: In experienced hands, TOT is an effective and safe procedure to treat SUI, with minimal complications in severe obese women.

Análisis prospectivo de la obesidad y el efecto de la cirugía bariátrica en la incontinencia urinaria

“…La tasa de fracaso de las mujeres con un imc >35 kg/m2 es muy alta, 81% alcanzan la continencia, en comparación con el 92% al 96% en la población general. (19,20) El papel de la cirugía bariátrica en la incontinencia urinaria y el mejoramiento de la calidad de vida sigue siendo poco estudiado. Los trastornos del piso pélvico, la incontinencia urinaria, el prolapso de órganos pélvicos y la incontinencia fecal, afectan de 50.9 al 75% de las mujeres que se someten a cirugía de pérdida de peso y en otras series del 60-70%, con una prevalencia del 28% para el tipo de iue, 4% iuu y 32% para ium y en otras series 37.7% iuu y 59% iue.…”

Urinary Continence Resolution after Bariatric Surgery: Long-Term Results after Six-Year Follow-Up

“…After failure of medical treatment, sub-urethral slings can be proposed to treat SUI in women. For women with a BMI ≥ 35 kg/m 2 , the results of sub-urethral slings are poor: only 81% achieve continence vs. 96% in the general population [ 6 ]. Weight loss for obese women who suffer from urinary incontinence is recommended too by the European Association of Urology (EAU) [ 7 ].…”