Slings effective, safe in obese, incontinent women

November 1, 2007

No matter which sling surgeons use to treat incontinence in obese women, results are similar-and good-with minimal complications.

That was the conclusion of researchers from Louisiana State University Health Sciences Center in Shreveport, who conducted a retrospective chart study of sling surgeries in obese women.

The correlation between obesity and incontinence is well defined. Obese women are nearly twice as likely (1.7 times) as their thinner sisters to have stress urinary incontinence. Louisiana was just the place for this study, first author Rashel M. Haverkorn, MD, a urology resident at Louisiana State University, Shreveport, pointed out. Louisiana's obesity rate is 30.8%, making the Pelican State among the top five states in the prevalence of obese women (37%).

Dr. Haverkorn, working with Alexander Gomelsky, MD, and colleagues, reviewed charts of 181 women with BMIs over 30 who underwent surgery for placement of suburethral slings of three different materials: anterior rectus fascia (40 women), porcine dermis (102 women), and polypropylene (39 women). Minimum follow-up was 12 months; mean follow-up was 34 months. No significant demographic differences or rates of previous surgeries were noted among the groups, Dr. Haverkorn reported at the AUA annual meeting in Anaheim, CA.

About 20% of each group had concomitant repairs, including abdominal hysterectomy, vaginal hysterectomy, anterior and posterior repair, and vaginal vault suspension. Mean follow-up times were shorter for the polypropylene sling (15 months vs. 39 for rectus fascia and 29 for porcine dermis, p<.001) because the procedure was relatively new at their hospital.

Cure for these women was considered completely dry, with a score of 0 on the SEAPI (stress incontinence, emptying, anatomy, protection, inhibition) scale; completely confident of their continence, ie, using no pads; happy with the results, evidenced by a score of 2 or less on a visual analog scale of satisfaction; and would have the surgery again and recommend it to a friend. Improvement was considered to be >50% improvement in continence, a reduction in pad use, and improvement on the visual analog scale of satisfaction.

Cure, improvement, and failure rates were not significantly different among the groups. In the rectus fascia group, surgery produced cures in 68% of the women, improvement in 25%, and failure in 8%. In the porcine dermis group, the corresponding percentages were 60%, 30%, and 11%, and in the polypropylene sling group, 74%, 15%, and 10%.

There were also no significant differences in SEAPI and quality of life scores and satisfaction among the groups. Between 91% and 95% said they would undergo the procedure again and 95% to 100% would recommend it to a friend.

Similar numbers of women suffered no complications of surgery (72% to 75%), and there were no significant differences in the rates of mild (4% to 5%) and moderate (3% to 5%) urinary retention across all groups. There was a significant difference in the rate of obturator pain, which affected 8% of women undergoing a procedure with a transobturator polypropylene sling versus no women receiving the other two types of slings, but this was transient and resolved within a 30-day period.

So many patients had concomitant procedures that data on patients who had only slings were too small for meaningful statistical analysis, but their cure rates and complication rates were similar to those of the larger group, the authors noted.