Complications After Surgery for Incontinence and Prolapse in Obese Women
Complications After Surgery for Incontinence and Prolapse in Obese Women
Haverkorn RM, Williams BJ, Kubricht WS, Gomelsky A
J Urol. 2011;185:987-992
Obesity is defined as a body mass index (BMI) of 30 kg/m or greater and is a growing problem in the United States. The prevalence rate of obesity in the United States has risen from an estimated 47% in 1976-1980 to 66% in 2003-2004. There are many comorbidities associated with obesity such as hypertension, atherosclerosis, heart disease, arthritis, and stroke. In addition, it is known that obesity is associated with increased risk for pelvic floor prolapse, overactive bladder (OAB), and stress urinary incontinence (SUI). It is also known that weight loss can improve symptoms of OAB and SUI in obese patients. However, weight loss may not be a viable option for all obese patients with urinary symptoms; the patient may not be able to adequately lose weight or the level of improvement seen with the urinary complaints may be inadequate. The article reviewed this month evaluated how obesity affected success and complication rates in patients undergoing surgery for SUI.
The authors retrospectively reviewed the records of all patients who underwent sling surgery at their institution since 2001. During the time period reviewed, 3 types of sling procedures were performed: autologous rectus fascia (ARF), acellular porcine dermis with Pelvicol® (Bard, Covington, Georgia) (PD) and transobturator polypropylene mid-urethral sling using the Monarc™ system (AMS, Minnetonka, Minnesota) (PP). A total of 709 patients with a minimum follow-up of 12 months were identified and these patients were then divided into 2 categories -- 412 patients with a BMI less than 30 kg/m (94 ARF, 157 PD, 161 PP) and 297 with a BMI greater than 30 kg/m (66 ARF, 114 PD, 117 PP). Outcomes evaluated for success included stress, emptying, anatomic, protection, and instability (SEAPI) score, pad use/day, Incontinence Impact Questionnaire, Urogenital Distress Inventory-6, and a visual analog score (0-terrible to 10-excellent). Global cure was defined as a composite SEAPI score of 0 and a visual analog scale score of 8-10. SUI cure was defined as no subjective complaints of SUI (SEAPI score = 0) and a negative cough stress test with a comfortably full bladder.
There were no demographic or anatomic differences between obese and nonobese women in each sling group. In addition, when stratified by BMI, there were no differences in regard to prior pelvic surgeries, daily pad use, or preoperative SEAPI score among the 3 sling groups as well. Global cure rates and SUI cure rates were found to be significantly higher for nonobese women undergoing each of the 3 sling procedures. However, significant improvements in SEAPI scores and quality-of-life indices were noted for all groups; a statistical difference was not noted between obese and nonobese women. The percentage of women who would undergo the surgery again and would recommend the surgery to a friend was high, and a statistical difference was not noted between obese and nonobese women. There was no overall difference in complication rates between obese and nonobese women; however, there was a statistically higher incidence of postoperative obstruction in nonobese women undergoing ARF or PP.
The authors concluded that although cure rates are lower for obese women undergoing surgery for SUI, a significant improvement was still seen in these patients after surgery. In addition, obesity did not appear to increase the risk for postoperative complications. Prior studies reviewing this subject have found a variety of results. Obesity was thought to be a significant risk factor leading to worse outcomes and increased perioperative complications. However, recent literature would suggest similar outcomes for obese and nonobese women undergoing midurethral sling. Chen and colleagues found no statistical difference in rate of perioperative complications between obese and nonobese women, although they did have a higher rate of operative site infection. Other studies have found that obese women have a higher bladder puncture rate and incidence of postoperative urge incontinence.
Is Obesity a Risk Factor for Failure and Complications After Surgery for Incontinence and Prolapse in Women?
Haverkorn RM, Williams BJ, Kubricht WS, Gomelsky A
J Urol. 2011;185:987-992
Study Summary
Obesity is defined as a body mass index (BMI) of 30 kg/m or greater and is a growing problem in the United States. The prevalence rate of obesity in the United States has risen from an estimated 47% in 1976-1980 to 66% in 2003-2004. There are many comorbidities associated with obesity such as hypertension, atherosclerosis, heart disease, arthritis, and stroke. In addition, it is known that obesity is associated with increased risk for pelvic floor prolapse, overactive bladder (OAB), and stress urinary incontinence (SUI). It is also known that weight loss can improve symptoms of OAB and SUI in obese patients. However, weight loss may not be a viable option for all obese patients with urinary symptoms; the patient may not be able to adequately lose weight or the level of improvement seen with the urinary complaints may be inadequate. The article reviewed this month evaluated how obesity affected success and complication rates in patients undergoing surgery for SUI.
The authors retrospectively reviewed the records of all patients who underwent sling surgery at their institution since 2001. During the time period reviewed, 3 types of sling procedures were performed: autologous rectus fascia (ARF), acellular porcine dermis with Pelvicol® (Bard, Covington, Georgia) (PD) and transobturator polypropylene mid-urethral sling using the Monarc™ system (AMS, Minnetonka, Minnesota) (PP). A total of 709 patients with a minimum follow-up of 12 months were identified and these patients were then divided into 2 categories -- 412 patients with a BMI less than 30 kg/m (94 ARF, 157 PD, 161 PP) and 297 with a BMI greater than 30 kg/m (66 ARF, 114 PD, 117 PP). Outcomes evaluated for success included stress, emptying, anatomic, protection, and instability (SEAPI) score, pad use/day, Incontinence Impact Questionnaire, Urogenital Distress Inventory-6, and a visual analog score (0-terrible to 10-excellent). Global cure was defined as a composite SEAPI score of 0 and a visual analog scale score of 8-10. SUI cure was defined as no subjective complaints of SUI (SEAPI score = 0) and a negative cough stress test with a comfortably full bladder.
There were no demographic or anatomic differences between obese and nonobese women in each sling group. In addition, when stratified by BMI, there were no differences in regard to prior pelvic surgeries, daily pad use, or preoperative SEAPI score among the 3 sling groups as well. Global cure rates and SUI cure rates were found to be significantly higher for nonobese women undergoing each of the 3 sling procedures. However, significant improvements in SEAPI scores and quality-of-life indices were noted for all groups; a statistical difference was not noted between obese and nonobese women. The percentage of women who would undergo the surgery again and would recommend the surgery to a friend was high, and a statistical difference was not noted between obese and nonobese women. There was no overall difference in complication rates between obese and nonobese women; however, there was a statistically higher incidence of postoperative obstruction in nonobese women undergoing ARF or PP.
The authors concluded that although cure rates are lower for obese women undergoing surgery for SUI, a significant improvement was still seen in these patients after surgery. In addition, obesity did not appear to increase the risk for postoperative complications. Prior studies reviewing this subject have found a variety of results. Obesity was thought to be a significant risk factor leading to worse outcomes and increased perioperative complications. However, recent literature would suggest similar outcomes for obese and nonobese women undergoing midurethral sling. Chen and colleagues found no statistical difference in rate of perioperative complications between obese and nonobese women, although they did have a higher rate of operative site infection. Other studies have found that obese women have a higher bladder puncture rate and incidence of postoperative urge incontinence.