THE TRANSOBTURATOR TAPE IN OBESE WOMEN

B. Özel, S. Minaglia, S. Malik, R. Urwitz-Lane, E. Hurtado, J.J. Klutke

USC Keck School of Medicine, Los Angeles, CA

OBJECTIVE: Our objective was to evaluate the effect of obesity on the outcome of the transobturator tape (TOT).

METHODS: We prospectively evaluated all women who had the TOT procedure between October 2003 and August 2004.  Intraoperative and postoperative complications were recorded.  Subjective cure was determined by a negative answer to the question “Do you experience urine leakage related to physical activity, coughing, or sneezing?”  The women were divided into three groups based on body mass index (BMI):  nonobese (BMI < 30 kg/m2), obese (30 kg/m2 < BMI < 35 kg/m2), and very obese (BMI > 35 kg/m2).  Data were analyzed using Chi-square analysis and two-sided Student's t test.

RESULTS: Ninety women underwent the TOT in the specified time period.  Thirty-five women were nonobese, 30 women were obese, and 25 women were very obese.  There were no differences in age, parity, height, pre-operative diagnosis, or pre-operative maximum urethral closure pressure.  Complications included one bladder perforation in the nonobese group; one case of de novo urge incontinence and one case of dissection urethrotomy in the obese group; and two vaginal perforations, one bladder perforation, one tape erosion, and one vaginal hematoma in the very obese group.  Complication rates in the very obese group were higher and approached statistical significance when compared to the nonobese women (p=0.07); however, three of these complications occurred in the same patient.  Sixty-three women had at least 6 weeks of follow-up.  At a median of 3-month (range 1.5-11 months) follow-up, subjective cure was 100% (22/22) in the nonobese group, 91.3% (21/23) in the obese group (p=0.49 compared to non-obese group), and 77.8% (14/18) in the very obese group (p=0.03 compared to non-obese group).

CONCLUSION: Complication rates of the TOT are low and do not appear to be significantly different in nonobese, obese, and very obese women in this small sample.  Subjective cure rate of stress incontinence following the TOT is significantly lower in the very obese women when compared to nonobese women.

Key Words: obesity, transobturator tape, stress incontinence

Disclosure – Consultant: J.J. Klutke, Mentor Corp.