Particularités de la prise en charge de l'incontinence urinaire d'effort de la femme obèse

Obesity, defined as a BMI over 30, is an increasing health problem all over the world. In most studies, a stronger association is observed between increasing weight, urinary incontinence and genital prolapse. Urinary incontinence (UI) prevalence is greater than 5 for women obviously obese. Specifically, stress UI management needs specificities in this population. Weight loss and pelvic floor muscles training are the first step of treatment. A 10% weight loss induces a 50% reduction of episodes of leakage. Unfortunately, weight reduction is usually non-lasting. In stress UI with urethral mobility, sub-urethral sling should be the second step. BMI < 35 seemed to be the best cutoff level. In that case, cure and complications rates are the same than in normal weight women. Above 35, there is a sharp decrease in cure rate (around 50%), and an increased risk of de novo urgencies and postoperative complications. For that obese women population, obesity surgery shows similar results than tension free vaginal tape. From a technical point of view, bladder injury is specific to retropubic access and should be avoided with transobturator access. On the other hand, retropubic access is likely to give longer lasting results on obese women whenever an intrinsic sphincter deficiency, a low urethral mobility and high intra-abdominal pressures are risk factors for failure.