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Published in: International Urogynecology Journal 3/2015

01-03-2015 | Original Article

The influence of the modifiable life-style factors body mass index and smoking on the outcome of mid-urethral sling procedures for female urinary incontinence

Authors: Katja Stenström Bohlin, Maud Ankardal, Corinne Pedroletti, Håkan Lindkvist, Ian Milsom

Published in: International Urogynecology Journal | Issue 3/2015

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Abstract

Introduction and hypothesis

The aim of this observational study was to investigate the influence of body mass index (BMI) smoking and age on the cure rate, rate of complications and patient satisfaction with mid-urethral sling (MUS) procedures.

Methods

Pre-, peri- and postoperative (8 weeks and 1 year) data were retrieved from the Swedish National Register for Gynecological Surgery of MUS procedures (retropubic procedures, n = 4,539; transobturator procedures, n =1,769) performed between January 2006 and December 2011. Multiple logistic regression analyses were performed between the outcome variables and BMI and smoking, presented as adjusted odds ratios (adjOR) with 95 % confidence interval (CI).

Results

Subjective 1-year cure rate was 87.4 % for all MUS procedures (88.3 % with the retropubic technique and 85.2 % with the transobturator technique (p = 0.002). Preoperative daily urinary leakage and urgency were more common with increasing BMI, but surgery reduced symptoms in all BMI groups. Lower cure rate was seen in women with a BMI >30 (0.49; CI 0.33–0.73), in diabetics (0.50; CI 0.35–0.74) and women aged > 80 years (0.18; CI 0.06–0.51). Perioperative complications were more common in the retropubic group (4.7 % vs 2.3 % in the transobturator group, p=0.001) and in women with BMI < 25. Smoking did not influence any of the outcome variables.

Conclusions

The overall 1-year cure rate for MUS procedures was 87 %, but was negatively influenced by BMI >30, diabetes and age > 80 years. Perioperative complications were more common with the retropubic procedure than with the transobturator technique, and in women with a BMI < 25. Smoking did not impact on any of the studied outcome variables.
Literature
1.
go back to reference Milsom I, Altman D, Cartwright R, Lapitan MC, Nelson R, Sillén U, Tikkanen K (2013) Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Health Publications, Paris Milsom I, Altman D, Cartwright R, Lapitan MC, Nelson R, Sillén U, Tikkanen K (2013) Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal incontinence (AI). In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Incontinence. Health Publications, Paris
3.
go back to reference Kuuva N, Nilsson CG (2002) A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 81(1):72–77CrossRefPubMed Kuuva N, Nilsson CG (2002) A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 81(1):72–77CrossRefPubMed
4.
go back to reference Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C (2013) Seventeen years’ follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J 24(8):1265–1269. doi:10.1007/s00192-013-2090-2 CrossRefPubMed Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C (2013) Seventeen years’ follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J 24(8):1265–1269. doi:10.​1007/​s00192-013-2090-2 CrossRefPubMed
5.
go back to reference Hunskaar S (2008) A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn 27(8):749–757CrossRefPubMed Hunskaar S (2008) A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn 27(8):749–757CrossRefPubMed
6.
8.
go back to reference Dunivan GC, Connolly A, Jannelli ML, Wells EC, Geller EJ (2009) Body mass index as a risk factor for cystotomy during suprapubic placement of mid-urethral slings. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1127–1131. doi:10.1007/s00192-009-0915-9 CrossRefPubMed Dunivan GC, Connolly A, Jannelli ML, Wells EC, Geller EJ (2009) Body mass index as a risk factor for cystotomy during suprapubic placement of mid-urethral slings. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1127–1131. doi:10.​1007/​s00192-009-0915-9 CrossRefPubMed
9.
go back to reference Lovatsis D, Gupta C, Dean E, Lee F (2003) Tension-free vaginal tape procedure is an ideal treatment for obese patients. Am J Obstet Gynecol 189(6):1601–1604, discussion 1604-1605CrossRefPubMed Lovatsis D, Gupta C, Dean E, Lee F (2003) Tension-free vaginal tape procedure is an ideal treatment for obese patients. Am J Obstet Gynecol 189(6):1601–1604, discussion 1604-1605CrossRefPubMed
10.
go back to reference Killingsworth LB, Wheeler TL 2nd, Burgio KL, Martirosian TE, Redden DT, Richter HE (2009) One-year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1103–1108CrossRefPubMedCentralPubMed Killingsworth LB, Wheeler TL 2nd, Burgio KL, Martirosian TE, Redden DT, Richter HE (2009) One-year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women. Int Urogynecol J Pelvic Floor Dysfunct 20(9):1103–1108CrossRefPubMedCentralPubMed
11.
go back to reference Hellberg D, Holmgren C, Lanner L, Nilsson S (2007) The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 18(4):423–429CrossRefPubMed Hellberg D, Holmgren C, Lanner L, Nilsson S (2007) The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 18(4):423–429CrossRefPubMed
13.
go back to reference Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Urogynecol J 21:25–26. doi:10.1007/s00192-00009-00976-00199 Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Urogynecol J 21:25–26. doi:10.​1007/​s00192-00009-00976-00199
14.
go back to reference Kulseng-Hanssen S (2003) The development of a national database of the results of surgery for urinary incontinence in women. BJOG 110(11):975–982CrossRefPubMed Kulseng-Hanssen S (2003) The development of a national database of the results of surgery for urinary incontinence in women. BJOG 110(11):975–982CrossRefPubMed
15.
go back to reference Kulseng-Hanssen S, Borstad E (2003) The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence. BJOG 110(11):983–988CrossRefPubMed Kulseng-Hanssen S, Borstad E (2003) The development of a questionnaire to measure the severity of symptoms and the quality of life before and after surgery for stress incontinence. BJOG 110(11):983–988CrossRefPubMed
16.
go back to reference Ladfors MB, Lofgren ME, Gabriel B, Olsson JH (2002) Patient accept questionnaires integrated in clinical routine: a study by the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand 81(5):437–442CrossRefPubMed Ladfors MB, Lofgren ME, Gabriel B, Olsson JH (2002) Patient accept questionnaires integrated in clinical routine: a study by the Swedish National Register for Gynecological Surgery. Acta Obstet Gynecol Scand 81(5):437–442CrossRefPubMed
18.
go back to reference Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, Kraus SR, Chai TC, Lemack GE, Dandreo KJ, Varner RE, Menefee S, Ghetti C, Brubaker L, Nygaard I, Khandwala S, Rozanski TA, Johnson H, Schaffer J, Stoddard AM, Holley RL, Nager CW, Moalli P, Mueller E, Arisco AM, Corton M, Tennstedt S, Chang TD, Gormley EA, Litman HJ (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362(22):2066–2076. doi:10.1056/NEJMoa0912658 CrossRefPubMedCentralPubMed Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, Kraus SR, Chai TC, Lemack GE, Dandreo KJ, Varner RE, Menefee S, Ghetti C, Brubaker L, Nygaard I, Khandwala S, Rozanski TA, Johnson H, Schaffer J, Stoddard AM, Holley RL, Nager CW, Moalli P, Mueller E, Arisco AM, Corton M, Tennstedt S, Chang TD, Gormley EA, Litman HJ (2010) Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 362(22):2066–2076. doi:10.​1056/​NEJMoa0912658 CrossRefPubMedCentralPubMed
20.
go back to reference Dwyer PL, Lee ET, Hay DM (1988) Obesity and urinary incontinence in women. BJOG 95(1):91–96CrossRef Dwyer PL, Lee ET, Hay DM (1988) Obesity and urinary incontinence in women. BJOG 95(1):91–96CrossRef
21.
go back to reference Cadish LA, Hacker MR, Dodge LE, Dramitinos P, Hota LS, Elkadry EA (2010) Association of body mass index with hip and thigh pain following transobturator midurethral sling placement. Am J Obstet Gynecol 203(5):508. doi:10.1016/j.ajog.2010.07.023, e501-505PubMed Cadish LA, Hacker MR, Dodge LE, Dramitinos P, Hota LS, Elkadry EA (2010) Association of body mass index with hip and thigh pain following transobturator midurethral sling placement. Am J Obstet Gynecol 203(5):508. doi:10.​1016/​j.​ajog.​2010.​07.​023, e501-505PubMed
22.
go back to reference Haverkorn RM, Williams BJ, Kubricht WS 3rd, Gomelsky A (2011) Is obesity a risk factor for failure and complications after surgery for incontinence and prolapse in women? J Urol 185(3):987–992CrossRefPubMed Haverkorn RM, Williams BJ, Kubricht WS 3rd, Gomelsky A (2011) Is obesity a risk factor for failure and complications after surgery for incontinence and prolapse in women? J Urol 185(3):987–992CrossRefPubMed
25.
go back to reference Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, Wollum A, Sanman E, Wulf S, Lopez AD, Murray CJ, Gakidou E (2014) Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 311(2):183–192. doi:10.1001/jama.2013.284692 CrossRefPubMed Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, Wollum A, Sanman E, Wulf S, Lopez AD, Murray CJ, Gakidou E (2014) Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA 311(2):183–192. doi:10.​1001/​jama.​2013.​284692 CrossRefPubMed
26.
go back to reference Sadr Azodi O, Lindstrom D, Adami J, Bellocco R, Linder S, Wladis A (2008) Impact of body mass index and tobacco smoking on outcome after open appendicectomy. Br J Surg 95(6):751–757. doi:10.1002/bjs.6079 CrossRefPubMed Sadr Azodi O, Lindstrom D, Adami J, Bellocco R, Linder S, Wladis A (2008) Impact of body mass index and tobacco smoking on outcome after open appendicectomy. Br J Surg 95(6):751–757. doi:10.​1002/​bjs.​6079 CrossRefPubMed
Metadata
Title
The influence of the modifiable life-style factors body mass index and smoking on the outcome of mid-urethral sling procedures for female urinary incontinence
Authors
Katja Stenström Bohlin
Maud Ankardal
Corinne Pedroletti
Håkan Lindkvist
Ian Milsom
Publication date
01-03-2015
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 3/2015
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-014-2508-5

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