OBJECTIVE To review the current literature and summarize the effect of obesity on outcomes of surgical treatment of pelvic floor disorders (PFDs) as well as the effect of weight loss on PFD symptoms. DATA SOURCES Relevant sources were identified by a MEDLINE search from 1966 to 2007 (key words: obesity, pelvic floor disorders, urinary incontinence, fecal incontinence, pelvic organ prolapse). References of relevant studies were hand searched. METHODS OF STUDY SELECTION Relevant human observational studies, randomized trials, and review articles were included. 246 articles were identified; 20 were used in reporting and analyzing the data. Meta-analyses were performed for topics meeting the appropriate criteria. TABULATION, INTEGRATION AND RESULTS There is good evidence that surgery for stress urinary incontinence in obese women is as safe as in their non-obese counterparts, but cure rates may be lower in the obese patient. Meta-analysis revealed cure rates of 81% and 85% for the obese and non-obese groups, respectively [P < 0.001; OR: 0.576 (95% CI: 0.426 – 0.779)] Combined bladder perforation rates were 1.2% in the obese and 6.6% in the non-obese [P = 0.015; OR: 0.277 (95% CI: 0.098 – 0.782)]. There is little evidence on which to base clinical decisions regarding the treatment of fecal incontinence (FI) and pelvic organ prolapse (POP) in obese women, as few comparative studies were identified addressing the outcomes of prolapse surgery in obese patients compared to normal-weight controls. Weight loss studies indicate that both bariatric and non-surgical weight loss lead to significant improvements in PFD symptoms. CONCLUSION Surgery for UI in obese women is safe, but more trials are needed to evaluate its long-term effectiveness as well as treatments for both FI and POP. Weight loss, both surgical and non-surgical, should be considered in the treatment of PFDs in the obese woman.

BACKGROUND Participants in the multi-center, randomized Total or Supracervical Hysterectomy (TOSH) trial showed within-group improvement in pelvic floor symptoms 2 years post-surgery and no differences between supracervical (SCH) versus total hysterectomy (TAH). This study describes longer term outcomes from the largest recruiting site. STUDY DESIGN Questionnaires addressing pelvic symptoms, sexual function, and health-related quality of life were administered. Linear models and McNemar’s test were utilized. RESULTS Thirty-seven participants (69%) responded (19 TAH, 18 SCH); mean follow up was 9.1±0.7 years. No between-group differences emerged in urinary incontinence, voiding dysfunction, pelvic prolapse symptoms and overall health related quality of life (HRQOL). Within-group analysis showed significant improvement in the ability to have and enjoy sex (P = 0.002) and in the SF-36 physical component summary score (P = 0.03) among women randomized to TAH. CONCLUSION 9 years after surgery, TOSH participants continue to experience improvement and show no major between-group differences in lower urinary tract or pelvic floor symptoms conferring no major benefit of SCH over TAH.

Objective To characterize differences in health-related quality of life among women presenting for treatment of fecal incontinence. Methods Among 155 women presenting for treatment of fecal incontinence in a specialty clinic, validated questionnaires measured impact on quality of life (Modified Manchester Health Questionnaire) and severity (the Fecal Incontinence Severity Index). Bowel symptoms, including frequency, urgency, and stool consistency, were ascertained. Co-morbid diseases were self-reported. Linear regression models were constructed from significant univariate variables to examine differences seen in quality of life scores. Results Average age was 58.7 ± 11.5 with no differences found in quality of life scores according to race, body mass index, or number of vaginal deliveries (p > 0.05). Younger age, increased urinary incontinence symptoms, prior cholecystectomy, prior hysterectomy, and severity of bowel symptoms correlated with a negative impact on quality of life in univariate analysis (p <0.05). Average severity scores were 30.5 ± 13.7 with moderate correlation seen with increasing severity and quality of life scores (R2= 0.60). After controlling for severity, women had increased quality of life scores with more bowel urgency (15 points, 95% CI 8.1, 21.2), harder stool consistency (10 points, 95% CI 3.8, 16.3), and prior hysterectomy (9 points, 95% CI 2.7, 15.4). Conclusion Bowel symptoms and having a prior hysterectomy had the greatest negative impact on quality of life in women seeking treatment for fecal incontinence. Targeting individualized treatments to improve bowel symptoms may improve quality of life for women with fecal incontinence.

No abstract

Maximum flow rates on preoperative uroflowmetry were the best predictor of passing an initial voiding trial after undergoing a mid urethral sling procedure for incontinence. However, the ability to maintain performance on a second voiding trial, even only 3 hours after passing an initial trial, is not assured.