Michel Levardon

Body Mass Index and Outcome of Tension-Free Vaginal Tape

OBJECTIVES To assess the effectiveness of tension-free vaginal tape (TVT) in women with high body mass indices (BMIs). METHODS Thirty-eight consecutive patients with BMIs exceeding 30 who underwent tension-free vaginal tape were compared with 149 consecutive patients with BMIs of 30 or less who underwent the same procedure. Body mass index was calculated pre-operatively and at follow-up. Women were classified as being of normal weight (BMI 20-25), overweight (BMI 26-30), or obese (BMI >30). Patient characteristics, operative and post-operative complications, reported continence rates were analyzed according to BMI. RESULTS There were no significant differences between groups in terms of age, parity, menopausal status, previous surgery, type and degree of incontinence. Estimated blood loss, operative times, bladder injuries, post-operative urgency and voiding disorders did not differ significantly between women with high BMIs and those with low BMIs. Women with BMIs exceeding 30 had a significantly higher incidence of post-operative urge urinary incontinence (17.9 versus 3.4 and 6.4% p = 0.02) without any effects on the objective and subjective cure rates (82 versus 88.7 and 93% p = 0.1, 71.7 versus 72.1 and 74% p = 0.9). CONCLUSION We did not find pre-operative obesity to be a risk factor for failure of tension-free vaginal tape.

A French Multicenter Clinical Trial of SPARC for Stress Urinary Incontinence

OBJECTIVE To evaluate the safety and efficacy of the SPARC procedure in women with genuine stress urinary incontinence. METHODS We conducted a prospective multicenter trial of a suprapubic approach to suburethral polypropylene (SPARC) taping for the treatment of genuine stress urinary incontinence. Between June 2001 and June 2002, 104 consecutive women (mean age 58.7 years) underwent SPARC in three centers. All the women had urethral hypermobility preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 3, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical and urodynamic examination, and the subjective cure rate was assessed using the Kings and Bristol questionnaire. RESULTS The mean follow-up time was 11.9+/-1.9 months (range 8 to 20 months). The mean operating time was 30 min (25-50 min). Most of the patients received general anesthesia (48%). The overall complication rate was 44.2% (46/104). The perioperative complication rate was 10.5%, including 11 bladder injuries. A significant difference in the bladder injury rate was observed between women with and without previous incontinence surgery (respectively 4/11, 36.3% versus 7/93, 7.5%; p<0.001). No hemorrhaging occurred. The early postoperative complication rate was 22.1%. The main complication was voiding disorders (11 patients), which necessitated intermittent self-catheterization for less than 15 days (1.3+/-1.1 days, range 1 to 10 days). The late postoperative complication rate was 11.5%, including de novo urge symptoms in 12 women. The objective cure rate was 90.4%. No difference was found between patients with genuine stress incontinence and those with mixed incontinence. The subjective cure rate was 72%. The objective and subjective cure rates differed significantly (p<0.05). The subjective cure rate among patients with de novo urge symptoms was 58%. CONCLUSION The SPARC procedure is a safe and effective treatment for women with stress urinary incontinence, despite a high incidence of de novo urge symptoms.

Vaginal hysterectomy for benign disorders in obese women: a prospective study.

Objective  To compare the morbidity of vaginal hysterectomy in obese and non‐obese women in a single institution.