Sling surgery for stress incontinence tied to poor outcomes in women with obesity

The findings of the study Have been published in Neurourology and Urodynamics.

Stress urinary incontinence (SUI) is the most common type of urinary incontinence and is currently considered a public health problem.Studies have shown that The risk of developing incontinence increases 20% to 70% every five units over a normal body mass index (BMI).

Synthetic mid-urethral slings (MUS) are the gold standard for surgical treatment of SUI with an overall success rate of 70% to 80%. Despite the high rates of cure reported with MUS, there is still a group of patients in whom the surgery fails.

Obesity is one of the main risk factors for worse surgical outcomes. However, the literature is heterogeneous and inconclusive.

With this background, Catalina Barco‐Castillo et al ,from the Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, sought to carry out the study to perform a systematic review and meta‐analysis to evaluate cure rates and perioperative complications in obese women.

Data was collected from a literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid‐urethral sling surgery, were identified. A systematic review of subjective and objective cure rates and complications was performed.

On analysis, the following facts are revealed.

• A total of 219 studies were identified.
• Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m2 ) and nonobese (<30 kg/m2 ). Complications could not be meta‐analyzed. The meta‐analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32‐2.16]) and objective (RR = 1.62 [95% CI: 1.26‐2.07]) cure rates disfavored obese women.>(<30 kg/m2). Complications could not be meta‐analyzed.
• The meta‐analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32‐2.16]) and objective (RR = 1.62 [95% CI: 1.26‐2.07]) cure rates disfavored obese women.

"According to our results, we consider it important to counsel SUI patients and provide noninvasive treatment for weight loss before MUS surgery." said the authors.

For full article click in the link: https://doi.org/10.1002/nau.24459

Primary source: Neurourology and Urodynamics