ORIGINAL ARTICLE Clinical impact of body mass index on the outcome of the SPARC-sling system for the treatment of female stress urinary incontinence Badereddinn Mohamad Al-Ali • Georg C. Hutterer • Erika Puchwein • Karl Pummer • Giacomo Novara • Gu ¨ nter Primus Received: 26 June 2011 / Accepted: 21 November 2011 / Published online: 4 December 2011 Ó Springer-Verlag 2011 Abstract Purpose Of this observational study was to evaluate the clinical outcome of the suprapubic arc (SPARC)-sling system in women with stress urinary incontinence according to body mass index (BMI). Materials and methods A total of 151 women underwent SPARC between June 2001 and March 2009 at a single tertiary academic center. A complete urodynamic investi- gation was performed preoperatively. A minimum follow- up of 12 months was required, which left data of 93 indi- viduals for analyses. Participants were divided into the following: A, non-obese (BMI 18.5 to \ 25 kg/m 2 ), B, overweight (BMI 25 to \ 30 kg/m 2 ), and C, obese (BMI 30–35 kg/m 2 ). Objective and subjective cure rates, as well as overall success rate and self-perceived severity of bother, were measured. Moreover, participants were asked about their satisfaction after surgery. Results Median follow-up was 7.6 years. Mean number of pads/day, pad test, and self-perceived severity of bother were significantly reduced overall, as well as in each BMI category (P \ 0.001). In multivariable analyses, BMI was not an independent predictor of objective cure rate, coded either as continuous (P = 0.108) or as categorical variable (P for trend 0.301). Similarly, BMI was not an independent predictor of subjective cure rate, both coded as continuous (P = 0.475) and as categorical variable (P for trend 0.690). Overall, 92% (A), 85% (B), and 80% (C) of participants were satisfied with the surgical outcome at follow-up, respectively. Conclusions BMI failed to achieve independent predictor status regarding objective and subjective cure rate at fol- low-up. A high BMI is not a contraindication to SPARC, more studies are recommended to confirm these findings. Keywords Body mass index Á Objective and subjective cure rate Á SPARC Á Stress urinary incontinence Abbreviations WHO World Health Organization SUI Stress urinary incontinence TVT Tension-free vaginal tape SPARC Suprapubic arc-sling system BMI Body mass index VAS Visual analogue scale IQR Interquartile ranges MUCP Maximum urethral closure pressure Introduction Obesity tends to become a major global health problem [1]. According to recent World Health Organization (WHO) cri- teria, more than 30% of adults in the United States are obese [2]. Similarly, obesity is a growing health burden in Western European countries [3, 4]. WHO’s projections for 2015 indi- cate that globally 2.3 billion adults will be overweight, and more than 700 million adults will be obese [5]. Stress urinary incontinence (SUI) is common, affecting up to 41% of the female population [6]. In Austria, one million inhabitants are estimated to suffer from SUI, B. Mohamad Al-Ali (&) Á G. C. Hutterer Á E. Puchwein Á K. Pummer Á G. Primus Department of Urology, Medical University of Graz (MUG), Auenbruggerplatz 7, 8036 Graz, Austria e-mail: bader1971@gmx.at G. Novara Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy 123 World J Urol (2013) 31:875–880 DOI 10.1007/s00345-011-0805-x