Tension-free vaginal tape procedure is an ideal treatment for obese patients

Objectives The purpose of this study was to evaluate the effect of obesity on the success of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence. Specifically, do patients with a body mass index (BMI) of 35 kg/m2 or greater have a lower cure rate of stress urinary incontinence? Study design This retrospective cohort study identified 35 patient pairs who had undergone TVT in Winnipeg, Manitoba, Canada, for stress urinary incontinence from November 1999 to July 2001. Obese patients (defined as BMI greater than or equal to 35 kg/m2) were paired with nonobese patients (defined as BMI less than or equal to 30 kg/m2). The subjects were matched for age (within 5 years) and prior continence surgeries. Patients with a maximum urethral closure pressure of less than or equal to 20 cm H2O were excluded. Follow-up was either by objective cough stress test or subjective cure assessed by telephone interview. Cure was defined as no postoperative stress incontinence. Statistical analysis was performed by conditional logistic regression for matched controls. Results The follow-up range was 6 to 24 months. There were seven failures in all, four in obese and three in nonobese patients, giving cure rates of 88.6% and 91.4%, respectively. This difference was not statistically significant (P > .05). There were five bladder perforations (identified at the time of the procedure), all occurring in nonobese patients (P<.05). Conclusion These data do not demonstrate a difference in cure of TVT in obese versus nonobese patients. Given the finding of fewer complications, this procedure may be an ideal surgical treatment modality for stress urinary incontinence in obese women.