Background
One subjective long‐term evaluation of the tension‐free vaginal tape (TVT) success rate in obese women showed a worse prognosis in the obese, but objective studies have been limited to short‐term follow‐up (less than two years).

Aim
To determine whether the long‐term objective cure rate in obese/morbidly obese women who underwent TVT was reduced, compared to non‐obese women (at five or more years).

Materials and methods
Body mass index (BMI) was collected on patients undergoing TVT procedure. Recruited patients were asked to perform a 24 h pad test and complete an International Consultation on Incontinence Questionnaire Short Form (ICIQ‐SF) at five years postoperatively. Data was analyzed according to pre‐operative urodynamic diagnoses and BMI, using ‘routine’ and ‘strict’ objective definitions of objective cure.

Results
At median follow‐up of 64 months (interquartile range 58–80 months), 136 patients returned a pad test and ICIQ‐SF. Using a routine definition of cure (pad test of ≤10 g in a 24 h period), 96% of patients were cured overall. The BMI results (n = 119 patients) were stratified into ≤25, 25.1–35 and ≥35.1 kg/m2, which represented 41, 53 and 6% of patients, respectively. The routine cure rates for these three groups were 98, 97 and 71%, respectively (P = 0.004).

Conclusion
Long‐term objective outcomes of the TVT in morbidly obese women are significantly poorer than in women with a normal BMI.