Does patient weight influence the outcome of the tension-free vaginal tape procedure?

Abstract

Urinary stress incontinence (USI) is more common in obese women. The influence of obesity on surgical treatment for USI is controversial. We sought to determine whether obesity affects the outcome of the tension-free vaginal tape (TVT) procedure. The retrospective data of 81 women that underwent the TVT procedure between 04/1998 and 12/2000 were studied. The study cohort women (aged 37-87 years) were subdivided into three groups according to body mass index (BMI): normal (BMI = <25)-group 1, overweight (BMI = 25-29)-group 2, and obese (BMI = >30)-group 3. All women underwent preoperative examinations, including detailed medical history and physical examination with stress tests and urodynamic studies. Follow-up included post-procedure check-up meetings at 1, 3, 6, and 12 months and once yearly thereafter (minimal follow-up = 52 months). Intra-and postoperative complications and success rates were compared among the three groups. Twenty-six (32.1%) women had normal BMI, 21 (25.9%) were overweight, and 34 (42%) were obese. Six intraoperative complications were recorded, including 5 bladder injuries and 1 urethral injury, none of which required surgical re-intervention. Eight reported postoperative complications included 1 bladder erosion, 3 urethral obstructions, 4 vaginal erosions (1 patient suffered from concomitant urethral obstruction and vaginal erosion). Five patients diagnosed with postoperative surgical complications underwent corrective surgery. There were no significant intergroup differences among the complication rates. The success rates were 84.6%, 81%, and 79.4% in groups 1, 2, and 3 respectively. Increased BMI may have a slight negative impact on TVT results, but the long-term success rate of 79.4% in obese women and the lack of any direct correlation between BMI and complications sanction their undergoing TVT.

Urethral injury associated with minimally invasive mid‐urethral sling procedures for the treatment of stress urinary incontinence: a case series and systematic literature search

“…Fifteen of these papers were case reports and 23 presented case series of between 17 and 2543 women; these latter studies were used to calculate rates of urethral perforation. The median rate urethral injury at retropubic tape procedures from 13 studies was 0.88% (range 0.1-5.5%) (59/3587), [21][22][23][24][25][26][27][28][29][30][31][32][33] and for transobturator foramen tape procedures in ten studies was 1.09% (range 0.0-2.5%) (19/4459); 3,12,34-41 these estimates are not significantly different (P = 0.25 Mann-Whitney; 95% CI for difference )0.002, 0.010).…”