The Role of Obesity in Success and Complications in Patients Undergoing Retropubic Tension-Free Vaginal Tape Surgery for Stress Urinary Incontinence
Alexander A. Berger, MD, MPH1; TingTing Zhan, PhD2; Joseph M. Montella, MD, MS3
1Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA; 2Department of Biostatistics , Thomas Jefferson University, 3Cooper University Healthcare, Camden, NJ
To examine the impact of obesity on the success rate of and complications from retropubic tension-free vaginal tape (TVT) midurethral slings for stress urinary incontinence (SUI).
•The prevalence of stress urinary incontinence (SUI) is 4-35%.
•Approximately 66% of women are overweight or obese
•Both SUI and obesity are becoming more common.
•Obesity is associated with SUI, which may be secondary to increased intra-abdominal pressure which can lea to weakening of the pelvic floor musculature and innervation.
•TVT is common surgical treatment for SUI.
•TVT success/complication rates may be influenced by BMI.
MATERIALS & METHODS
•A retrospective, cohort study was performed on patients between 2008 and 2014.
•SUI diagnosed based on a normal postvoid residual (PVR), a negative urinary analysis (UA), and a positive cough stress test.
•Demographic, outcome, and complication data were obtained from electronic medical records.
•Short term defined as 1-2 weeks post-operative, long term defined as 2 months post-operative.
•Cure was defined as patients who had a negative cough stress test, and self-reported resolution of SUI symptoms.
•R statistical software used t0 analyze data using logistic regression, Poisson regression, ANOVA, and multivariate regression analysis.
•Compared to normal weight patients, obese patients had a OR of 3.56 (p=0.03) of short term failure, and a OR of 1.65 (p=0.39) of long term failure.
•Compared to normal weight patients, obese patients had a OR of 3.39 (p=0.003) of long-term urge urinary incontinence
•Odds of intraoperative complications did not differ between overweight and normal weight (OR=0.64, p=0.319), and obese and normal weight (OR=0.90, p=0.83) patients
•There were no statistical significant differences in change in hemoglobin or procedure time
•Postoperative complications did not differ between overweight and normal weight (OR=0.40, p=0.27) and obese and normal weight (OR=1.45, p=0.54) patients.
CONCLUSIONS AND CLINICAL IMPLICATIONS
•Obese women undergoing retropubic TVT surgery had 3.56 increased odds of short term failure, as well as a trend toward increased long term failure
•There was no statistical significant difference in complications for obese and overweight patients when compared to patients of normal weight
•Obese patients were nearly 3.5 times more likely to have long-term postoperative UUI.
•Limitations included no formal postoperative data collection beyond 2 months, a lack of racial diversity and statistical power to detect small differences in rare outcomes
The findings of this study support that for obese women undergoing TVT surgery there is an association with increased treatment failure, but not with an increased risk of intra-operative or postoperative complications. Obese women are more likely to experience postoperative voiding dysfunction and UUI. This information can help guide surgical planning when counseling overweight and obese patients with SUI considering TVT.