Stress urinary incontinence (SUI) is the non controlled loss of urine during coughing or physical activity, mostly due to a weak pelvic floor or urethral sphincter and having a significant impact on the patient's quality of life. Sling surgery is the gold standart in the surgical treatment of  SUI. Unfortunately, despite the with higher results of this surgeries, about 20% of patients are incontinent postoperatively and this situation is common in obese patients. In this study we are evaluated the  results of surgical treatment of SUI in morbidly obese (BMI >40) patients with transobturator adjustable slings Urosling (Lintex).

To our study we are included 70 morbidly obese female who underwent transobturator adjustable sling surgery between 2015 and 2019. Perioperatively all patients were evaluated by Stamey degree of incontinence, cough test, pad use, q-tip test, ICIQ-SF questionnaire, uroflowmetry and residual urine check. All surgeries performed by single, experienced surgeon. All cases performed under spinal anesthesia, by performing cough test with 300cc bladder filling after gentle tightening of the sling. Special attention is paid to the prevention of overcorrection
The control readjustment was performed under local anesthesia the next day after surgery if it required.

Mean age of patients was 67.3±9.1 years. 32 (45,7%) had prior pelvic floor surgery, 47 (67,1%) patients presented with grade 3 stress urinary incontinence, other 23 (32,8%) presented with grade 2 stress urinary incontinence according the Stamey classification. The preoperative pad use was 5,7 dail.  The mean operative time was 21.3±11.4 min. No intraoperative complications like bleeding, bladder injury. 31 (44/2%)  patient was continent, readjustment of sling performed next day after surgery for 39 (55,7%) patients, who had signs of urinary incontinence during cough test. All patients were continent after readjustment with no residual urine. 6 (0.08%) patient felt pain after surgery which controlled by painkillers.  Hospital stay period was 2 days for all patients.  Mean follow up was 12 months, overall success rate was in 66 (95%) patients, 2 (2.85%) had 1 pad during 24 hour, 1(1,4%) no feedback.

Our series demonstrates that the use of the adjustable transobturator sling is particularly beneficial for obese patients. In morbidly obese patients a considerable success rate is achievable with transobturator adjustable sling surgery. The procedure can be regarded as safe as no complications were observed in this group of patients in part with multiple risk factors

The individual adjustability of the sling in order to achieve an adequate degree of tension to the urethra is the key factor in restoring continence in this selected cohort of morbidly overweight patients

Noblett KL, Jensen JK, Ostergard DR. The relationship of body mass index to intra-abdominal pressure as measured by multichannel cystometry. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8:323–326.
Shkarupa D.D., Kubin N.D., Staroseltseva O.Y., Zaytseva A.O., Pisarev A.V., Shapovalova E.A. ADJUSTABLE TRANSOBTURATOR SLING FOR TREATING PATIENTS WITH COMPLICATED STRESS URINARY INCONTINENCE.  Urology Herald. 2017;5(4):58-68.