Effect of Obesity on the Success of Single-Incision Sling Procedures for Urodynamic Stress Incontinence

The primary aim was to evaluate the impact of body mass index (BMI) category on objective and subjective cure following single incision sling (SIS) surgery for stress urinary incontinence (SUI). The secondary aim was to compare outcomes among different SIS types within and across BMI categories.

This retrospective study included 636 women (mean age 57.4 ± 10.4 years) with urodynamic SUI who underwent SIS using the Ophira, Solyx, or I-stop mini between 2015 and 2023. Patients were stratified into BMI categories: normal (< 25 kg/m²), overweight (25-29.9 kg/m²), and obese (≥ 30 kg/m²). Objective cure was defined as no leak on urodynamic testing and the 1-h pad test < 2 g, while subjective cure was based on patient-reported outcomes using the UDI-6.

Objective and subjective cure rates differed across BMI categories, with the highest rates observed in patients with normal BMI (93.1% and 90.5%) and the lowest in obese patients (77.8% and 75%). Within each BMI category, cure rates did not differ significantly by sling type. However, when outcomes were examined across BMI categories for individual sling types, fixed-length SIS (Ophira and Solyx) showed a significant decline in cure rates with increasing BMI, whereas the adjustable length I-stop mini maintained more consistent outcomes. Independent risk factors for failure included age ≥ 66, menopause, intrinsic sphincter deficiency (ISD), and maximal urethral closure pressure (MUCP) < 40 cm H₂O.

BMI category is associated with SIS outcomes, with obese patients demonstrating lower cure rates compared with normal BMI patients. While sling type does not influence outcomes within BMI groups, preoperative counseling is essential for high-risk patients.