Long-term outcomes of free synthetic sling placement for the treatment of urinary incontinence in patients with morbid obesity

BACKGROUND: Stress urinary incontinence is the most common lower urinary tract disorder in women. Obesity notably increases the risk of this condition. Surgical correction using a free synthetic sling is considered the gold standard of treatment; however, long-term outcomes in patients with morbid obesity remain controversial.

AIM: This work aimed to evaluate the long-term outcomes of urethropexy using a free synthetic sling in patients with urinary incontinence and morbid obesity.

METHODS: A comparative analysis of treatment outcomes was performed in 81 women with urinary incontinence and morbid obesity, divided into two groups according to the surgical approach: transobturator (n = 40) and retropubic (n = 41). Treatment outcomes were assessed at 1, 3, and 6 months postoperatively. Long-term results were evaluated after 12 months or longer. Follow-up examinations included vaginal examination with cough stress test, uroflowmetry, bladder ultrasonography with assessment of postvoid residual urine volume, and completion of the UDI-6, ICIQ-SF, and I-QOL questionnaires.

RESULTS: The median age was 57.5 years [51.5; 63.5] in the transobturator group and 61 years [54; 65] in the retropubic group. The median body mass index was 38.9 kg/m² [36.9; 40.1] in the transobturator group and 39.1 kg/m² [37.2; 40.5] in the retropubic group. The mean postoperative follow-up period was 12 ± 2.4 months. Patients in both groups reported improved quality of life. The rate of recurrent urinary incontinence based on the cough stress test was 6 cases (14.6%) in the transobturator group and 4 cases (10%) in the retropubic group.

CONCLUSION: A free synthetic sling is an effective method for the correction of stress urinary incontinence in patients with morbid obesity. A lower recurrence rate in the long-term period was observed in the retropubic approach group.