The Outcome of a Single-Incision Sling versus Trans-Obturator Sling in Overweight and Obese Women with Stress Urinary Incontinence at 3-Year Follow-Up.

Hui-Hsuan Lau,Wen-Chu Huang,Tsung-Hsien Su,Sugarmaa Enkhtaivan

doi:10.3390/jcm8081099

Abstract

Background: Being overweight or obese is a risk factor for incontinence and has negative impacts on the surgical outcomes. Compared with trans-obturator sling (TOS), single incision sling (SIS) is a new generation of anti-incontinence surgery. However, the data on SIS in overweight and obese women remains limited. Methods: This retrospective study analyzed the objective and subjective cure rate of overweight and obese women who underwent sling surgeries. Other evaluations included valid questionnaires to assess quality of life and 1-hour pad test to quantify urine leakage. Surgical characteristics and adverse events were also analyzed. Results: A total of 217 patients were analyzed with a median follow-up period of 37.3 months (range, 9–84 months). For overweight and obese patients, the objective and subjective cure rate were comparable (all p > 0.05). However, the SIS group had worse post-operative incontinence-related symptom distress (p < 0.001) and 1-hour pad test (p = 0.047). On the other hand, SIS had a shorter surgery time (p = 0.017) and lower pain score (p < 0.001). Conclusions: Compared with TOS, SIS had non-significant cure rates in the overweight and obese women. SIS had worse urine leakage and incontinence symptoms, but less surgical and wound pain in obese women. Thorough pre-operative counseling is necessary.

Highlights

Stress urinary incontinence (SUI) is defined by the International Urogynecological Association and International Continence Society as involuntary loss of urine on effort, physical exertion, sneezing, or coughing [1]
A urodynamic evaluation study reported an association between increased body mass index (BMI) and increased intra-abdominal pressure [6], and another cohort study reported a dose-response effect of body weight on SUI symptoms, with each 5-unit increase in BMI being associated with a 20–70% increase in the risk of incontinence [4]
A total of 723 women received a mid-urethral sling for SUI during the study period, of whom 384 were overweight or obese

Summary

Introduction

Stress urinary incontinence (SUI) is defined by the International Urogynecological Association and International Continence Society as involuntary loss of urine on effort, physical exertion, sneezing, or coughing [1]. Numerous risk factors are associated with SUI including aging, obesity, pregnancy, childbirth, hysterectomy, menopause, or heavy lifting work [2]. Compared with trans-obturator sling (TOS), single incision sling (SIS) is a new generation of anti-incontinence surgery. Methods: This retrospective study analyzed the objective and subjective cure rate of overweight and obese women who underwent sling surgeries. For overweight and obese patients, the objective and subjective cure rate were comparable (all p > 0.05). The SIS group had worse post-operative incontinence-related symptom distress (p < 0.001) and 1-hour pad test (p = 0.047). Conclusions: Compared with TOS, SIS had non-significant cure rates in the overweight and obese women. SIS had worse urine leakage and incontinence symptoms, but less surgical and wound pain in obese women.

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