Levin Pamela June, Wu Jennifer M, Siddiqui Nazema Y, Amundsen Cindy L
Division of Urogynecology, Department of Obstetrics and Gynecology, Duke Urogynecology, Durham, NC 27707, USA.
Female Pelvic Med Reconstr Surg. 2012 Jul-Aug;18(4):243-6. doi: 10.1097/SPV.0b013e31826150fe.
Some providers believe obesity may be a relative contraindication for InterStim; however, the relationship between obesity and treatment outcome has not been evaluated. Our objectives were to compare the test phase (stage 1) success and complications of obese versus nonobese women undergoing a 2-stage InterStim procedure for refractory urge urinary incontinence (UUI).
We conducted a retrospective cohort study of obese and nonobese women who underwent stage 1 InterStim for refractory UUI. We compared the stage 1 success, defined as undergoing stage 2 generator implantation after demonstrating improvement of 50% or greater during test phase and intraoperative and postoperative complications within 1 year between obese and nonobese cohorts.
Of 149 subjects, 80 (53.7%) were obese (body mass index, 37.3±5.87 kg/mg), and 69 (46.3%) were nonobese (body mass index, 25.6±2.82 kg/m). The overall stage 1 success was 81%. No statistically significant difference existed in stage 1 success between obese and nonobese cohorts (83% vs 78%, P=0.52). In a logistic regression model controlling for obesity, age, preoperative incontinence episodes per 24 hours, psychiatric diagnoses, arthritis, and diabetes mellitus, age per decade was the only variable significantly associated with stage 1 InterStim success (odds ratio, 0.61; 95% confidence interval, 0.39-0.96). Complications were also similar between cohorts (obese 20% vs nonobese 13%, P=0.26).
In women undergoing staged InterStim therapy, stage 1 success and complications were similar between obese versus nonobese women. These data suggest that obesity should not be considered a limiting factor when determining whether a patient is a candidate for InterStim therapy for treatment of refractory UUI.
一些医疗服务提供者认为肥胖可能是骶神经调节疗法（InterStim）的相对禁忌证；然而，肥胖与治疗结果之间的关系尚未得到评估。我们的目的是比较肥胖与非肥胖女性在接受两阶段InterStim手术治疗难治性急迫性尿失禁（UUI）时测试阶段（第1阶段）的成功率和并发症情况。
我们对接受第1阶段InterStim治疗难治性UUI的肥胖和非肥胖女性进行了一项回顾性队列研究。我们比较了第1阶段的成功率，其定义为在测试阶段显示改善50%或更多后接受第2阶段发生器植入，以及肥胖和非肥胖队列在1年内的术中和术后并发症情况。
在149名受试者中，80名（53.7%）为肥胖者（体重指数，37.3±5.87kg/m²），69名（46.3%）为非肥胖者（体重指数，25.6±2.82kg/m²）。第1阶段的总体成功率为81%。肥胖和非肥胖队列在第1阶段的成功率无统计学显著差异（83%对78%，P = 0.52）。在一个控制了肥胖、年龄、术前每24小时尿失禁发作次数、精神疾病诊断、关节炎和糖尿病的逻辑回归模型中，每增加十岁的年龄是与第1阶段InterStim成功显著相关的唯一变量（优势比，0.61；95%置信区间，0.39 - 0.96）。队列之间的并发症也相似（肥胖者20%对非肥胖者13%，P = 0.26）。
在接受分期InterStim治疗的女性中，肥胖与非肥胖女性在第1阶段的成功率和并发症相似。这些数据表明，在确定患者是否为InterStim治疗难治性UUI的候选者时，肥胖不应被视为一个限制因素。
