Obesity is a well-known risk factor for stress urinary incontinence (SUI) (1), likely due to chronically increased intra-abdominal pressure, and has been associated with poorer surgical outcomes (2). Consequently, some centers restrict access to surgical treatment based on body mass index (BMI). The aim of this study was to compare ultrasound outcomes and complications of mid-urethral sling (MUS) surgery—minisling (Altis®) and retropubic sling (TVT-Exact®)—between obese and normal-weight women, one month after surgery.

This retrospective study included 154 women who underwent MUS surgery in a tertiary university urogynecology unit. A total of 58 minislings and 96 TVT slings were implanted, with 76.6% performed as isolated procedures without concomitant prolapse repair.
Baseline variables included demographic data, clinical characteristics, physical examination, urogynecological ultrasound and urodynamic findings. Intraoperative complications and ultrasound outcomes at one month were recorded.
Patients were stratified according to BMI into normal-weight (BMI <30 kg/m²) and obese (BMI ≥30 kg/m²). A subgroup analysis was also performed for women with BMI ≥35 kg/m².

Baseline characteristics and one-month postoperative outcomes are summarized in Tables 1 and 2. Bladder injuries were rare (3/154, 1.9%) and occurred at similar rates across normal-weight and obese women. No significant differences were observed between groups in terms of postoperative complications symptoms or ultrasound findings at one month. Similarly, in the subgroup of women with BMI ≥35 kg/m², outcomes remained comparable to those of normal-weight patients.

Analysis of intraoperative complications, early postoperative symptoms suggestive of complications and one-month ultrasound findings showed no significant differences between normal-weight and obese women. Both groups demonstrated low rates of intraoperative events, minimal postoperative symptoms indicative of complications, and similar ultrasound parameters of sling position and urethral support.

MUS surgery is associated with low intraoperative and early postoperative complication rates, with favorable ultrasound outcomes at one month, regardless of patient BMI. Obese women experience comparable safety profiles to normal-weight women, suggesting that BMI alone should not preclude surgical intervention for SUI when appropriate preoperative assessment and surgical expertise are applied.

Barco-Castillo C, Plata M, Zuluaga L, et al. Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis. Neurourology and Urodynamics. 2020;39:2153–2160.
Fuselier, A., Hanberry, J., Margaret Lovin, J. et al. Obesity and Stress Urinary Incontinence: Impact on Pathophysiology and Treatment. Curr Urol Rep 19, 10 (2018).