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Effect of Morbid Obesity on Midurethral Sling Efficacy for the Management of Stress Urinary Incontinence

Elshatanoufy, Solafa, PharmD, MD, FACOG*; Matthews, Alexandra, MD; Yousif, Mairy, PhD; Jamil, Marcus, MD; Gutta, Sravanthi, MD§; Gill, Harmanjit, MD§; Galvin, Shelley L., MA∥¶; Luck, Ali M., MD*

Female Pelvic Medicine & Reconstructive Surgery: May 4, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000594
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Objectives The aim of our study was to assess midurethral sling (MUS) failure rate in the morbidly obese (body mass index [BMI] ≥40 kg/m2) population as compared with normal-weight individuals. Our secondary objective was to assess the difference in complication rates.

Methods This is a retrospective cohort study. We included all patients who underwent a synthetic MUS procedure from January 1, 2008, to December 31, 2015, in our health system. Failure was defined as reported stress urinary incontinence symptoms or treatment for stress urinary incontinence. Variables collected were BMI; smoking status; comorbidities; perioperative (≤24 hours), short-term (≤30 days), and long-term (>30 days) complications; and follow-up time. Statistics include analysis of variance, χ2 test, logistic regression, Kaplan-Meier method, and Cox regression.

Results There were 431 patients included in our analysis. Forty-nine patients were in class 3 with a BMI mean of 44.9 ± 5.07 kg/m2. Median follow-up time was 52 months (range, 6–119 months). Class 3 obesity (BMI ≥40 kg/m2) was the only group that had an increased risk of failure when compared with the normal-weight group (P = 0.03; odds ratio, 2.47; 95% confidence interval, 1.09–5.59). Obesity was not a significant predictor of perioperative, short-term, or long-term postoperative complications (P = 0.19, P = 0.28, and P = 0.089, respectively) after controlling for other comorbidities.

Conclusions Patients in the class 3 obesity group who are treated with an MUS are 2 times as likely to fail when compared with those in the normal-weight category on long-term follow-up with similar low complication rates.

From the *Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Henry Ford Health System | Wayne State University;

Department of Obstetrics and Gynecology, Henry Ford Health System;

Department of Urology; Henry Ford Health System; and

§Department of Obstetrics and Gynecology, Henry Ford Health System | Wayne State University, Detroit, MI; and

Division of Research, Grants and Library Services, Mountain Area Health Education Center; and

Department of Obstetrics and Gynecology, UNC School of Medicine, Asheville, NC.

Correspondence: Solafa Elshatanoufy, PharmD, MD, FACOG, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Henry Ford Health System | Wayne State University, 2799 W Grand Blvd, Detroit, MI 48202. E-mail: selshat1@hfhs.org.

The authors have declared they have no conflicts of interest.

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