Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Obstetrics & Gynecology
Humans, Female, Suburethral Slings, Urinary Incontinence, Stress, Quality of Life, Body Mass Index, Postoperative Period, Orthopedic Equipment
Objective: Stress urinary incontinence (SUI) is a prevalent subtype of urinary incontinence among women, reported by as many as 44-57% of middle-aged and postmenopausal women. Obesity is a known risk factor for SUI; however, literature investigating the impact of mid-urethral sling placement on quality of life (QoL) among women of varying BMI is limited and inconsistent. Validated questionnaires, including the abbreviated Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) are widely used in practice and research to assess symptoms, with high scores in both questionnaires indicating a greater symptom burden. This study analyzes pre- and post-operative QoL scores stratified by patient BMI through a retrospective analysis of patient quality of life before and after retropubic (TVT) sling placement in an academic urogynecologic practice.
Methods: We conducted a retrospective chart review of adult women with demonstrated SUI who underwent isolated TVT mid-urethral sling placement and completed standardized quality of life questionnaires. Demographic data was collected and correlated to UDI-6 and IIQ-7 quality of life survey responses routinely conducted pre-operatively and again one year after surgery.
Results: Retrospective analysis of demographic data along with pre- and 1-year post-operative UDI-6 and IIQ-7 quality of life questionnaire data for 204 women receiving TVT mid-urethral sling at an urogynecology practice between 2012 and 2018 shows improvement in QoL scores in women with increasing BMI <35kg/m2. Women with BMI between 25.0-29.9 kg/m2 had the greatest mean difference (8.9 points) in pre- and post-operative quality of life scores using the IIQ-7 questionnaire with women with a BMI >30.0 kg/m2 having a lesser degree of score improvement. However, women with BMI between 30.0-34.9 kg/m2 had the greatest mean difference in pre- and post-operative quality of life scores using the UDI-6 questionnaire (mean 6.6 points).
Conclusion: While overweight and obese women had higher UDI-6 and IIQ-7 pre-operative scores, there is no difference in quality of life improvement amongst women of varying BMI groups who received TVT slings for stress urinary incontinence. Overweight women with a BMI between 25.0-29.9 kg/m2 did have a noticeable increase in median IIQ-7 scores difference from normal weight women; however, this trend did not perpetuate amongst obese women. Limitations of the study include a small sample size which may preclude identification of clinically or statistically significant trends in quality of life scores.
Wilkes, Margaret; Brandes, Mary; and Foust-Wright, Caroline, "BMI and Post-operative Quality of Life Outcomes in Women Receiving Tension-Free Vaginal Tape (TVT) Slings for Isolated Stress Urinary Incontinence" (2020). Costas T. Lambrew Research Retreat 2020. 65.