Obesity is closely related to Stress Urinary Incontinence (SUI) as a contributary factor in causation as well as potentially affecting the outcome of treatment. Obesity is a major public health concern in the Western world and is a risk factor in etiopathogenesis of SUI (Fuselier, 2018). It is generally recommended for obese patients to reduce weight before they can be offered surgery to restore continence (Hellberg, 2007). It’s always a challenge for women with obesity and incontinence to reduce weight due to the bi-directional cause-effect relationship. The aim of this study was to find if a continence procedure can be offered to women with incontinence who are struggling to lose weight and are still classed as obese.

All patients with primary or refractory SUI were clinically assessed, BMI recorded and a pre-operative ICIQ-short form questionnaire filled. They all had Video Cystometry. Patients underwent autologous fascial sling or bladder neck suspension as deemed necessary by as single surgeon (VK). The patients were categorised into obese and non-obese based on standard WHO BMI parameters with obesity defined as BMI of over 30. Surgical outcomes and adverse effects were assessed and compared in both groups with failure of the procedure defined as any degree of stress urinary incontinence. Statistical analysis was performed using Student's-T test.

A total of 113 patients underwent a surgical procedure. These were divided into 2 groups, Group A being obese (BMI 30-48, mean=35.6) and Group B being non-obese (BMI 18.9-29.9, mean=25.6 ), with mean age of 51 for group A and 50.05 for group B. Eighteen from each group (total=36) had previous failed incontinence procedure. As per the table 1, the two groups were nicely matched in numbers, age, procedures performed and length of hospital stay. The complication rates were marginally higher in the obese group mainly related to post-op pain and wound infection when compared to non-obese group. The difference between the 2 groups remained marginal for de-novo urgency and failure of the procedure with no difference in post-op ICIQ-SF. Around 10% in both groups reported worsening of symptoms due to urinary urgency. Post op ISC rates in Group A were slightly higher with 10 performing ISC compared to group B which had 7, however 15 group A and 4 group B were on Botox pre-procedure. None of the parameters showed statistical significance.

The 2 groups, obese and non-obese were remarkably matched. The age, pre-op ICIQ-SF score, post-op ICIQ-SF score, previous continence procedure, hospital stay and emergence of de-novo urgency were very similar (p=NS). The outcomes in terms of failure of the procedure and early and late complications were statistically not significant.

Surgical procedures for stress urinary incontinence in obese are associated with minor early post-op complications which were statistically not significant as compared to non-obese women and most of these resolved within few days on conservative treatment. Long term outcomes of surgery are comparable to those in non-obese. This study suggests that early surgical intervention may be offered to patients with obesity if weight reduction is deemed not possible.

Fuselier, A., Hanberry, J., Margaret Lovin, J. et al. Obesity and Stress Urinary Incontinence: Impact on Pathophysiology and Treatment. Curr Urol Rep 19, 10 (2018)
Hellberg, D., Holmgren, C., Lanner, L. et al. The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. Int Urogynecol J 18, 423–429 (2007).