Urinary stress incontinence in obese women: tension‐free vaginal tape is the answer

Abstract

Objective To determine the effectiveness of the tensionfree vaginal tape (TVT) in obese women with genuine stress incontinence (GSI), in whom obesity is often considered a relative contraindication to surgical treatment by traditional approaches, e.g. Burch colposuspension and slings (which are dif®cult and carry increased morbidity) or injectable agents (which although simple, are unpredictable and expensive). Patients and methods Data on 242 consecutive women with urodynamically proven GSI were collected prospectively. The women were subdivided into three groups with a body mass index (BMI) of <25, 25±29 and o30; obesity was de®ned as a BMI of o30. All procedures were performed under spinal anaesthesia. The King's validated quality of life (QoL) questionnaires (version 7) were completed before and 6 months after surgery. The subjective results were de®ned as a cure, signi®cant improvement or failure. Results Almost 90% of the obese women with GSI were cured, while the remaining 10% noted a considerable improvement in their symptoms. There was no signi®cant difference in cure rates among the three groups. There was a highly signi®cant (P<0.001) improvement in QoL in all groups. Conclusion The TVT is at least as effective in obese women as in those with a lower BMI. The TVT is a simple and minimally invasive procedure, with low morbidity even in the obese group. TVT can be offered con®dently to all obese women with GSI.

Do severe obese patients with stress urinary incontinence benefit from transobturator tape procedure? 3-year surgical outcome

“…Some of these studies revealed no difference in the potential impact of obesity on TVT outcomes in shortterm follow-up (<1 year). [21][22][23] On the other hand, Hellberg and colleagues reported significant failure rates (52%) in the severely obese population (BMI >35) compared to non-obese women (19%) with long-term follow-up (mean 68 months). 24 Although TVT is a good option for severely obese patients with severe incontinence, TOT has become an acceptable alternative in the surgical treatment of SUI.…”

Comparison of one-year results of transobturator tape method in the stress incontinence treatment according to body mass index

“…In the prospective study conducted by Mukherjee et al [25] with 242 women who underwent SUI surgery, they divided these women into three groups according to their BMI and determined no difference between the rates of wound site infection and retropubic hematoma in the obese group.…”

Does patient weight influence the outcome of the tension-free vaginal tape procedure?

“…Recent studies reported high cure rates of 78.9% to 84.7% after long-term follow-up [15,16] and described relatively low intraoperative and postoperative complication rates [17]. However, there are few published short-term studies on the outcomes of the TVT procedure in overweight and obese women [13,[18][19][20]. Chung et al retrospectively compared the efficacy and safety of 91 cases of TVT procedures and 51 laparoscopic Burch procedures.…”

“…Given the finding of fewer complications, the authors suggested that this procedure might be an ideal surgical treatment modality for USI in obese women [13]. Mukherjee and Constantine [19] compared the data of 242 women who underwent the TVT procedure with a follow-up of 6 months. The cure rate was 85% in women with BMI <25, 95% in women with BMI 25-29, and 89% in women with BMI >30.…”

“…The cure rate was 85% in women with BMI <25, 95% in women with BMI 25-29, and 89% in women with BMI >30. There was no significant difference in the numbers of complications among the obese and the other groups, and the authors concluded that the TVT procedure is at least as effective in obese as in non-obese women; hence, this might be offered confidently to obese women with USI [19]. Rafii et al [20] compared the TVT procedure in 38 patients with BMI >30 and 149 patients with BMI <30.…”