Impact of severe obesity on long-term success and complications of the retropubic midurethral sling.

With conflicting evidence in the literature, we hypothesised that the long-term subjective outcomes of the retropubic midurethral sling (MUS) are the same in the severely obese and non-obese populations.

A retrospective matched cohort study was performed on women with a BMI ≥ 35 and < 30 who had a retropubic MUS placed between 2010 and 2015 using telephone questionnaires. The primary outcome was the success rate of surgery defined by the Urogenital Distress Inventory Short Form (UDI-6) stress subscale. Statistical analysis was performed to test for associations between primary and secondary outcomes across the two groups.

Seventy-eight severely obese (SOG) and 74 non-obese (NOG) were recruited. At a median time from surgery of 3.8 years the success rate was 47.4% in the SOG compared to 64.9% in the NOG (p = 0.03). There was a 22% reduction in the odds of success with every 5 unit increase in BMI (p = 0.03). There were higher rates of mixed urinary incontinence preoperatively (60.3% vs. 37.8%, p = 0.006) and persistent urinary urge incontinence postoperatively (48.7% vs. 32.4% p = 0.04) in the severely obese. Lower PGI-I scores were obtained in the severely obese group indicating less improvement in symptoms from surgery. There was no difference in complication rates between the groups.

Long-term subjective outcomes from the retropubic MUS are lower in severely obese women than in non-obese women with no difference in complication rates. High satisfaction and recommendation rates were found in both groups.

International urogynecology journal. 2020 Jul 06 [Epub ahead of print]

Nicola Dykes, Lynsey Hayward, Christin Coomarasamy

Department of Obstetrics and Gynaecology, Middlemore Hospital, Auckland, New Zealand. ., Department of Obstetrics and Gynaecology, Middlemore Hospital, Auckland, New Zealand., Research and Evaluation Office, Ko Awatea, Middlemore Hospital, Auckland, New Zealand.

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