Three-year follow-up of the effectiveness of treatment of very obese and very old women operated for stress incontinence by transobturator tape (TOT) and single incision tapes
Abstract
Objective of the study : To compare the efficacy of MiniArc, Monarc and TVT-O slings operations in women with stress urinary incontinence depending on a BMI and age in 3-year follow-up. Design : Retrospective study.
Settings : Department of Obstetrics and Gynecology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague. Methods: 430 patients were included and divided into three groups according to the type of the sling.
Each group was divided into subgroups according to BMI and age. All women were examined 6 weeks and 3 months after surgery.
Patients were contacted by telephone 3 years after the surgery and information about their quality of continence was gained. Results : In the group of patients with BMI >= 35 was no significant difference in efficacy compared to patients with lower BMI.
In the groups of the patients with TVT-O or Monarc were found lower failure rates (2.12 % resp. 0.92 %) compared to MiniArc minisling (8.04 %). MiniArc demonstrated statistically more failures in both groups of non-obese and obese patients (p = 0.008).
In the group of patients over 75 years of age statistically significant more failures were proved in MiniArc group (failure rate 29.41 %, n = 24) compared to patients up to 75 years (failure rate 7.69 %, n = 406), p = 0.001. In the Monarc and TVT-O groups no age difference in the effectiveness of the sling was demonstrated.
Conclusion : Single-incision sling is the suitable surgical method for the treatment of very obese patients. In our study, the 3-year follow-up did not prove a greater risk of failure MiniArc sling in women with a BMI >= 35.
Age of patients (>= 75 years) was a risk factor for failure of the operation only in MiniArc group. In the TVT-O and Monarc groups we did not prove higher failure rates depending on the patient's age.