SUFU 2019: Outcomes of Midurethral Slings in the Obese Woman

Miami, FL ( The prevalence of obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, has increased in women 60 years of age and older from 31.5% in 2003-2004 to 38% in 2011-2012. The Centers for Disease Control (CDC) further stratifies obesity into three classes: Class I (BMI 30-35), Class II (BMI 35-40), and Class III (BMI>40).

Obesity has been shown in multiple studies to be a risk factor for stress urinary incontinence (SUI), and it remains a viable option in these patients who seek treatment for SUI.  James E. Pilkington, MD, and his group at Louisiana State University Health Sciences Center-Shreveport reported the outcomes in obese women who underwent midurethral slings (MUS) at their institution. His group performed a retrospective chart review of women with BMI ≥ 30 who underwent top-down retropubic (RP) and outside-in transobturator (TO) MUS and had a minimum of 12 months’ follow-up. Women who had previous anti-incontinence surgery and those undergoing concomitant surgery were included. Pre-and postoperative assessment included routine examinations and validated quality of life (QoL) questionnaires. “Cure” was defined as patients with no subjective or objective findings of SUI post-operatively, in whom no additional procedures were needed to achieve continence.

From 1371 MUS procedures performed during the study period, 575 women met inclusion criteria. Mean follow-up time in this group of patients was 41 months. Of these, 405/575 (70%) had RP MUS, and 170/575 (30%) had TO MUS. Mean age, parity, baseline pad use, and preoperative QoL indices were not statistically different between RP and TO groups. 56% of patients had Class I obesity, 28% had Class II obesity, and 16% had Class III obesity.

The overall cure rate for the RP group was 65%; those with Class I, II, and III obesity had cure rates of 69%, 63%, and 57%, respectively. The overall cure rate for the TO group was 58%; those with Class I, II, and III obesity had cure rates of 62%, 58%, and 45%, respectively.

The investigators then isolated their study to include those women with isolated sling procedures for SUI. 83/142 (58%) in the RP group were cured; those with Class I, II, and III obesity had cure rates of 63%, 52%, and 55%, respectively. 31/57 (54%) in the TO group were cured; those with Class I, II, and III obesity had cure rates of 62%, 50%, and 42%, respectively. Perioperative complications were infrequent (Figure 1), with most being Clavien grade ≤ 3 and associated with concomitant surgery. Mean improvement in all QoL indices was seen in all groups, regardless of SUI cure, but that cure rates waned over longer follow-up for both groups.

Figure 1:
SUFU WM 2019 obsese women complications

Dr. Pilkington and his group concluded that SUI cure rates after MUS in the obese population are lower than those traditionally-quoted in the non-obese, and that longer periods of follow-up, increasing class of obesity, and TO MUS were risk factors for recurrent or persistent SUI.

However, MUS surgery in obese women was considered safe with an overall high satisfaction rate.

Presented By: James E. Pilkington, MD, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana

Written by: Judy Choi, MD, Assistant Professor, Department of Urology, University of California, Irvine @judymchoi at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida