TVTO Complication Rate Lower in Obese Women

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GLASGOW—Obese women have a lower incidence of pain, tape erosion, and voiding difficulty following a tension-free vaginal tape obturator (TVTO) mid-urethral sling procedure compared with normal weight women, but they have a lower subjective cure rate, according to investigators.

By objective measures, however, cure rates did not differ significantly. Obese women also had a lower rate of hospital readmission.

How Chuan Han, MD, of KK Women's & Children Hospital in Singapore, Malaysia, and colleagues divided 414 women undergoing TVTO for urinary incontinence into three groups—normal weight, overweight, and obese—and compared them with respect to TVTO success and complications.

Six months after treatment, the subjective cure rate was 96.5%, 94.5%, and 84.9% for the normal weight, overweight, and obese women, respectively, according to data presented at the International Continence Society annual meeting. The subjective improvement rate was 3.5%, 5.5%, and 14%, respectively, and the subjective failure rate was 0%, 0%, and 1.1%.

The objective cure rate by cough stress test was 97.7%, 98.6%, and 95.3%; the objective cure rate by urodynamic study was 95.1%, 94.8%, and 93.8%. For the obese women, the subjective cure rate was significantly lower than that of the normal weight women, but the objective cure rates were not.

At six months, 4.7%, 3.4%, and 2.3% of normal weight, overweight, and obese patients, respectively, had pain; 2.3%, 2.1%, and 1.2% had tape erosion; and 0%, 1.4%, and 0% had voiding difficulty. The readmission rate was 4.5%, 2.2%, and 1.8%.

Perioperatively, voiding difficulty developed in 47 patients (11.4%). Of these, 17 were from the normal-weight group, possibly because of the tendency to overcorrect, according to the researchers. The readmission rate was highest among the normal weight women because of voiding difficulty.

The finding that normal weight women had the highest tape erosion rate may be due to the tape lying closer to the vaginal mucosa in thinner patients, the investigators explained.

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