Early outcomes of the transobturator male sling based on body mass index

Little is known regarding factors that contribute to the long term success or failure of the transobturator male sling for stress urinary incontinence. The objective of this study was to compare the outcomes of the transobturator male sling for stress urinary incontinence based on body mass index (BMI).

A retrospective review was performed of 31 transobturator male slings placed at a single institution from 2008 to 2010. Success of the procedure was defined as resolution of leakage or great improvement of leakage by the Patient Global Impression of Improvement scale and lack of urinary leakage on postoperative physical exam. Patients were divided into one of three groups: ideal weight (BMI 18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (> 30 kg/m(2)). Outcomes and complications were compared between groups.

Etiology of urinary incontinence was radical prostatectomy in 28 patients and a transurethral procedure for infection or benign prostatic hypertrophy (BPH) in 3 patients. Successful treatment of incontinence was significantly higher in the ideal weight (7/8 or 88%) and overweight group (13/14 or 93%) in comparison to the obese group (4/9 or 44%), (p = 0.019). Postoperative complications were similar between groups.

Obese patients had lower success rates after transobturator sling in comparison to ideal and overweight patients. We feel this may be due to increased intra-abdominal pressure transmission to the bladder, urethra, and sling itself. These patients may be better candidates for an artificial urinary sphincter or should be counseled to undergo pre-preoperative weight loss to improve sling outcomes.