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Obesity Not a Cause of Failure in Tension-Free Tape Procedure for Incontinence: Presented at AUGS

By Paula Moyer

SAN DIEGO, CA -- August 4, 2004 -- Tension-free vaginal tape for urinary incontinence is just as successful a treatment for obese women as it is for nonobese women, according to findings presented here July 30^th at the 2004 American Urogynecologic Society/Society of Gynecologic Surgeons Joint Scientific Meeting.

"Obese women are no more likely to have failed procedures or complications from them than are women of more normal weight," according to principal investigator Begüm Özel, MD, a fellow in female pelvic medicine and reconstructive surgery at the Keck School of Medicine, University of Southern California in Los Angeles, California.

She and her coinvestigators conducted the study because obesity is common in the United States, with one third of women having a body mass index (BMI) of at least 30 mg/m², the threshold for obesity. Since obesity influences the technical aspects of a pelvic surgical procedure, the investigators speculated that obese patients could have a relatively high rate of failure with the midurethral sling procedure, as shown with recurrence of stress incontinence even at short-term follow-up. Therefore, they conducted a retrospective analysis in order to evaluate the outcome of the tension-free vaginal tape (TVT) procedure in obese women.

The women in the study had undergone the procedure at the researchers' institution between November 1998 and December 2002. The investigators categorized the women as nonobese, with a BMI of less than 30, and obese, with a BMI of at least 30. Urinary retention was defined as an inability to completely empty the bladder, as evidenced by a postvoid residual exceeding 100 cc.

The study protocol defined subjective outcomes as cure, improvement, and failure, based on the patient's self report of her symptoms. The investigators analyzed the data with Fisher's exact test, chi-square analysis, and the Student's t test.

Three hundred thirty one women underwent the tension-free vaginal tape procedure during the study period; among these, the investigators had height and weight data for 302. Within this group, 160 women had a BMI less than 30 while 142 women had a BMI greater than or equal to 30.

The women in the nonobese group were an average of 51.9±9.2 years old, compared to the obese group, who were an average of 49.2±7.7 years old (P = .005). The 2 groups were similar regarding gravity, parity, and height., and had similar histories of prior incontinence surgery and preoperative evidence of detrusor overactivity. The rates of several intra-operative and postoperative complications were also similar; these consisted of trocar cystotomy, retropubic hematoma, urinary tract infection, de novo detrusor overactivity, tape erosion, and infection. However, urinary retention that persisted more than 2 weeks was more likely to occur in the nonobese women, of whom 12.4% experienced this complication, compared to 5.5% of the obese women (P = .058).

The average follow-up was 8.0 months for the nonobese group and 8.3 months for the obese group (P = .66). The nonobese and obese groups had similar subjective cure rates, 89.7% and 87.5%, respectively (P = .57). They also had similar improvement rates, 7.5% of the nonobese patients and 8.6% of the obese patients (P = .83). Failed procedures occurred at similar rates 2.7% of women in the nonobese group and 3.9% of women in the obese group (P = .74).

"Obesity is apparently not a risk factor for failure of the tension-free vaginal tape procedure at short-term follow-up," according to Dr. Özel. She said that the increased rate of urinary retention in the nonobese women was unexpected, and may be due to the fact that these women were older than the patients in the obese group.


[Presentation title: Outcome of the Tension-free Vaginal Tape Procedure in Obese Women. Abstract 39]

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