Urinary stress incontinence: Obesity and the use of porcine dermal slings

Objective: The objective of this study was to determine if obesity is a risk factor for surgical failure of vaginal slings using a porcine dermal graft in the treatment of stress urinary incontinence. Methods: Fifty-four patients with objectively demonstrated stress incontinence (positive+ stress test) underwent correction with a vaginal sling comprised of a porcine dermal graft fixed into position with bone anchors and were retrospectively reviewed. Patient demographics and incontinence-related symptoms were evaluated in all patients. Additionally, a telephone interview for a predetermined protocol (Urogential Distress Inventory-short form) was performed within 7 to 27 months of surgery with a mean of 16 months. Body mass index (BMI) was calculated and patients were grouped into those less than or equal to 25 kg/m², 25 to 30 kg/m², and those greater than or equal to 30 kg/m². Patients who indicated absence of stress-related urine loss and pad use on the urogenital distress inventory short form were considered cured. Results: In the 54 patients who underwent surgical correction, 48 completed the study protocol. Of these, 26 had a BMI ≤25 kg/m², 12 had a BMI between 25 and 30 kg/m², whereas the remaining 10 had a BMI ≥30 kg/m². Mean length of follow up was 16.1 months, 16.3 months, and 15.4 months, respectively. Stress urinary incontinence was cured in 81%, 75%, and 50%, respectively, and improved >50% in an additional 11%, 0%, and 10%, respectively. Conclusions: Although minimally invasive, rapid, and safe, porcine dermal slings demonstrated lower success in obese women for the treatment of stress urinary incontinence.