THE SELECTION OF ACCESS TO SURGICAL TREATMENT FOR STRESS URINARY INCONTINENCE IN PATIENTS WITH MORBID OBESITY

Obesity negatively affects the quality of life and contributes to the development of diseases such as diabetes mellitus and hypertension. Women with a high body mass index are at risk of pelvic organ prolapse and urinary incontinence. Despite the recommendation for weight loss as the first line of therapy, this is often not possible. Therefore, sling operations are becoming the main method of treating urinary incontinence in patients with morbid obesity, but research on the choice of an approach to surgery is extremely limited. Objective. The purpose of the study was to conduct a comparative assessment of the results of the effectiveness and safety of urethropexy with a free synthetic loop by access to the transobturator and posadilon in patients with morbid obesity. Materials and Methods. The study was carried out in two groups of patients. The SUI-TO group of 41 patients underwent urethropexy with a free synthetic loop using transobturator access using the "inside-out" technique. The SUI-SP group of 40 patients underwent urethropexy with free synthetic loop with a posadilon access. The patients in the groups were comparable in age and body mass index. Each of the patients underwent a comprehensive clinical examination that included additional diagnostic methods. These included filling out the UDI-6, IIQ-7, ICIQ-SF and I-QOL questionnaires, vaginal examination in mirrors, cough stress test, uroflowmetry, ultrasound examination of the bladder to determine the volume of residual urine, as well as bacterial urine culture. Results. In the SUI-TO group, the average age was 61 years, in the SUI-SP group – 57.5 years. Body mass index was comparable: 39.1 and 38.9 kg/m2, respectively. Patient satisfaction was high, 14.6% and 10% having a positive cough stress test in the SUI-TO and SUI-SP groups, respectively. De novo urgency was observed in 9.7% and 20% of patients. Surgical treatment significantly improved quality of life, revealing no signs of obstructive urine or an increase in residual urine during the follow-up period.