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363 - OUTCOMES OF SUB URETHRAL SLINGS FOR STRESS URINARY INCONTINENCE IN THE OBESE POPULATION

363

OUTCOMES OF SUB URETHRAL SLINGS FORSTRESS URINARY INCONTINENCE IN THE OBESE POPULATION

H. DEVAKUMAR, N. CHANDRASEKARAN,L. MARTIN, J. S. SCHACHAR, G. DAVILA, E. A. HURTADO;
ClevelandClinic Florida, Weston, FL.

Introduction: The life time riskof stress urinary incontinence (SUI) and urge urinary incontinence(UUI) is increased in obese individuals 1. As theprevalence of obesity increases, more obese women with incontinencewill be pursuing surgical intervention. There is a substantial amountof controversy regarding treatment outcomes of suburethral slings inobese women. Despite reported cure rates 2, 3, there isinsufficient evidence to draw conclusions from existingstudies.
Objective: To evaluate the medium- term success ofsuburethral slings in the obese (body mass index of (BMI) ≥ 30) andnon-obese (BMI of < 30) population.
Methods: This is aretrospective cohort study of women who underwent suburethral slingplacement (Retro pubic- Gynecare TVT Ethicon, Somerville, NJ, I-StopCL Medical, Lyon, France or Transobturator- Monarc, Miniarc, AMS,Minnetonka, MN) between 2003 to 2015 using a prospectiveUrogynecologic database. Primary outcome was to evaluate successdefined as ‘cured’ or ‘greatly improved’, ‘somewhatimproved’ using a validated patient satisfaction score and anegative postoperative standardized stress test (SST). Statisticsincluded Pearson’s chi-square or Fisher’s exact test forcategorical variables, Wilcoxon for nonparametric variables andstudent t- test for continuous variables.
Results: A totalof 687 subjects [group 1, BMI < 30 (511), group 2 BMI ≥ 30(176)] with a mean follow up of 164 weeks (group 1) and 148 weeks(group 2) were included. There were 279 retropubic and 408Transobturator slings. Mean BMI in group 2 was 33.8 and 14.98 % werediabetic. 64 (12.52%) in group 1 had underwent a prior prolapseprocedure. (Table 1) Transobturator slings were commonly used ingroup 1 (61.06% vs 54.55%). Concomitant prolapse repairs wereperformed in 80.18% of group1 versus 71.01% (p 0.0059). Use of spinalanesthesia was more liberal in group 1 (41.1% vs 28.41%, p=0.0028)and general anesthesia in group 2 (67.6% vs 56.16%, p=0.0077).Intraoperative complications were not different between the twogroups. There was no significant difference in the primary outcome,subjective complaints of incontinence, voiding dysfunction and newonset urge incontinence. The re-intervention rates were not differentbetween the two groups. (Table 2)
Conclusions: There was nodifference in sling success between obese and non- obese population.Complication rates, reintervention rates are comparable between thetwo groups.
References: 1. J. Urology 2009; 182 (suppl):s2-7 2. Int Urogynecol J. 2015;26(5):641-8. 3. Obstet Gynecol.2008;112(2 PART 1):341-9.

Table1


Group1 (511)

Group2 (176)


Age

69.87(12.8)

68.27(12.7)

0.153

Parity

2(1,12)

2(1,6)

0.3

BMI

25.10(2.72)

33.8(3.62)

<0.0001

Diabetes

30(5.87)

24(13.64)

0.001

Smoking

25(4.89)

12(6.82)

0.0374

PriorAnti- Incontinence Surgery

27(5.28)

14(7.95)

0.197

Menopause

418(81.8)

135(76.7)

0.1412

RetropubicSlings

199(38.94)

80(45.45)

0.129

Transobturatorslings

312(61.06)

96(54.55)

0.129

SpinalAnesthesia

210(41.1)

50(28.41)

0.0028

GeneralAnesthesia

287(56.16)

119(67.61)

0.0077



Table2


Group1 (511)

Group2 (176)


PrimaryOutcome

404(79.06)

129(73.3)

0.113

PrimaryOutcome and no incontinent events

275(53.8)

90(51.14)

0.538

DenovoUrge Incontinence

59(11.55)

16(9.09)

0.3677

RepeatSling

6(1.17)

4(2.27)

0.2882

Bulkingagent

28(5.48)

9(5.11)

1

RepeatSling ad Bulking agent

3(0.59)

1(0.57)

1

Slingtransection

6(1.17)

3(1.70)

0.7007

Slingrevision

14(2.74)

1(0.57)

0.1322

Meshexposure

6(1.17)

6(3.41)

0.684

Mesherosion

1(0.20)

0

1

PostopVoiding dysfunction

17(3.33)

3(1.70)

0.434