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Updated: Sep 3, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Effect of Postoperative Weight Change on Outcomes After Midurethral Sling
Marcela Toro Bejarano1,2, Minita S Patel3, Okezi Obrutu4
1Division of Urogynecology and Reconstructive Pelvic Surgery, University of California San Francisco, San Francisco.
Importance:
Midurethral sling surgery is the gold standard surgical treatment for stress urinary incontinence, and many patients experience weight changes over time. The effect of these changes on long-term outcomes remains unclear.
Objective:
The objective of this study was to evaluate the association between postoperative weight change of at least 10% and long-term retreatment and complication outcomes after midurethral sling surgery.
Study Design:
This retrospective cohort study included adult women undergoing primary midurethral sling surgery for stress urinary incontinence between 2008 and 2019 within an integrated health care system. Eligible patients had at least 5 years of follow-up and longitudinal weight data. Postoperative weight change was categorized as stable (<10%) or at least 10% (loss, gain, or fluctuation). The primary outcome was retreatment for stress urinary incontinence identified using procedural codes. Secondary outcomes included sling-related complications. Multivariable logistic regression adjusted for age, body mass index, and comorbidities. Time to retreatment was assessed using Kaplan-Meier analysis.
Results:
Among 6,924 patients, 44.9% experienced at least 10% weight change. Overall, 5.2% underwent retreatment. Retreatment rates were lowest in the stable group (4.5%) and higher with weight gain (6.4%). Complications occurred in 16.5% and were lowest in the stable group (14.4%) and highest in the fluctuating group (26.4%). After adjustment, postoperative weight gain was independently associated with increased odds of stress urinary incontinence retreatment (adjusted odds ratio [aOR], 1.53; 95% CI, 1.17-1.99). Weight fluctuation had the strongest association with postoperative complications (aOR, 2.07; 95% CI, 1.49-2.84), followed by weight loss (aOR, 1.40; 95% CI, 1.18-1.65) and weight gain (aOR, 1.29; 95% CI, 1.09-1.52). Weight fluctuation was also independently associated with de novo urgency incontinence (aOR, 1.55; 95% CI, 1.12-2.12).
Conclusions:
Significant postoperative weight change may be associated with an increased risk of retreatment and complications. A better understanding of weight change patterns may improve long-term outcomes.
