Weltz V, Guldberg R, Lose G
Department of Obstetrics and Gynecology, Herlev University Hospital, Herlev, Denmark,
Int Urogynecol J. 2015 May;26(5):641-8. doi: 10.1007/s00192-014-2567-7. Epub 2014 Nov 19.
Obesity is associated with an increased prevalence of female stress urinary incontinence (SUI). Mid-urethral polypropylene sling is considered the surgical gold standard for treatment of SUI. We reviewed the current literature on efficacy at 1 year (or more) and perioperative safety of synthetic mid-urethral sling procedures for SUI in obese women.
A systematic search of PubMed, Embase and the Cochrane databases was performed using the MeSH terms "Stress urinary incontinence", "Overweight", "Obesity" and "Surgery". We included 13 full-text papers published from January 1995 to May 2014. We defined two groups of women: non-obese (BMI below 30 kg/m(2)) and obese (BMI above 30 kg/m(2)). Data regarding subjective and objective cure and selected perioperative complications were pooled and compared.
The pooled data from the 13 studies showed that 76.4% and 74.7% of non-obese and obese women, respectively, were subjectively cured (p = 0.70), and 83.3% and 79.2%, respectively, were objectively cured (p = 0.56). Bladder perforation was more frequently reported in non-obese women (p < 0.01). We did not detect a significant difference in postoperative urine retention or sling excision between the two groups (p = 0.36 and p = 0.17, respectively).
Cure rates were found to be comparable in obese and non-obese women. Perioperative complications were not reported to occur more often in obese women. The outcomes of sling procedures for SUI appear to be comparable in obese and non-obese women, and counselling of obese women regarding outcomes and perioperative complications can be similar.
肥胖与女性压力性尿失禁（SUI）患病率增加相关。尿道中段聚丙烯吊带被认为是治疗SUI的外科金标准。我们回顾了目前关于肥胖女性SUI的合成尿道中段吊带手术1年（或更长时间）疗效及围手术期安全性的文献。
使用医学主题词“压力性尿失禁”、“超重”、“肥胖”和“手术”对PubMed、Embase和Cochrane数据库进行系统检索。我们纳入了1995年1月至2014年5月发表的13篇全文论文。我们将女性分为两组：非肥胖组（BMI低于30kg/m²）和肥胖组（BMI高于30kg/m²）。汇总并比较有关主观和客观治愈情况以及选定围手术期并发症的数据。
13项研究的汇总数据显示，非肥胖和肥胖女性的主观治愈率分别为76.4%和74.7%（p = 0.70），客观治愈率分别为83.3%和79.2%（p = 0.56）。膀胱穿孔在非肥胖女性中报告更为频繁（p < 0.01）。我们未发现两组之间术后尿潴留或吊带切除有显著差异（分别为p = 0.36和p = 0.17）。
发现肥胖和非肥胖女性的治愈率相当。未报告肥胖女性围手术期并发症更常发生。SUI吊带手术在肥胖和非肥胖女性中的结果似乎相当，并且可以向肥胖女性提供关于结果和围手术期并发症的类似咨询。
