Transobturator Tape Procedure Outcomes Similar for the Obese

Success and complication rates were similar among obese, severely obese, and normal-weight women.
Success and complication rates were similar among obese, severely obese, and normal-weight women.

Obesity and severe obesity do not appear to increase the risk of surgical failure of the transobturator tape procedure (TOT) over 3 years, a new study finds.

Tarik Yonguc, MD, and colleagues of Izmir Bozyaka Training and Research Hospital in Izmir, Turkey, reviewed outcomes for 470 women (average age 53) with stress or mixed urinary incontinence who underwent a TOT procedure.  (Women with urge-predominant mixed incontinence were excluded.)

The investigators divided patients into 3 groups by body mass index (BMI) for analysis: the normal-weight group (BMI less than 25 kg/m2), obese group (BMI 30–34 kg/m2), and severely obese group (BMI 35-39 kg/m2). Morbidly obese women with a BMI above 40 were not studied. The investigators also chose to omit overweight women (BMI 25–29 kg/m2) to clarify differences associated with obesity.

Average operative time was significantly longer in the obese groups, according to results published in Urology. Passing the needle through the obturator foramen in obese women is more difficult than in slimmer patients, the researchers noted.

The rates of objective cure, subjective success, and patient satisfaction were similar between groups, however. Objective cure meant there was no need for re-operation, negative cough test results, and no need for pads. Subjective success was determined by lack of additional treatment, slight or moderate symptom scores on the International Consultation on Incontinence Questionnaire-Short Form, and satisfaction with surgery, as assessed by the visual analog scale (score of 80 or above).  More women in the severely obese group showed improvement instead of cure.

“The high satisfaction rate of both obese and severely obese women from surgery is respectable and encouraging for the surgeons who will perform anti-incontinence surgery in women in both these groups in the future,” according to the investigators.

They observed no meaningful differences in intra-operative and post-operative complications. Overall complication rates were similar at 10.4%, 11.1%, and 9.3% for the normal-weight, obese, and severely obese groups, respectively. New onset of urge urinary incontinence occurred in 1.9%, 2.7%, and 3.1%, respectively, with more severely obese women experiencing it. Urinary retention requiring catheterization was seen only in 1 normal-weight patient. No bladder or intestinal perforation occurred.

Groin and leg pain was the most common post-operative complication, occurring in 4.2% of patients. These symptoms resolved with non-steroidal anti-inflammatory drugs.

In an accompanying editorial, Steven P. Petrou, MD, of Mayo Clinic in Jacksonville, Fla., commented that the next hurdle will be management of the extremely obese (BMI greater than 40 kg/m2), who now constitute 8% of the U.S. female population. 

Sources

  1. Yonguc, T; Degirmenci, T; Bozkurt, IH; et al. Urology; doi: 10.1016/j.urology.2015.03.048.
  2. Steven P. Petrou. Urology; doi: 10.1016/j.urology.2015.03.051.
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