Does Bariatric Surgery Affect Urinary Incontinence?

The impact of bariatric surgery on urinary incontinence: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

Obesity and overweight are strongly associated with stress and urgency urinary incontinence, and weight loss has been associated with improvement in urinary incontinence. We aimed to measure pooled effect sizes for different weight loss procedures on incontinence-specific quality of life and incontinence cure rate in a systematic review and meta-analysis.

METHODS

MEDLINE, Embase and the Cochrane library were searched using a pre-defined strategy for relevant cohort studies. Random effects meta-analyses were conducted for the weighted mean difference for urinary quality of life scores and weighted overall pooled estimates for proportions of women cured. We explored heterogeneity using meta-regression, testing the type of bariatric surgery and change in BMI as predictors of effect size. The studies were categorised as either low or high risk of bias using a novel instrument specifically designed for longitudinal symptom research studies.

RESULTS

Twenty-three studies (n = 3,225) were included. Incontinence-specific quality of life scores were improved by 14% (weighted mean difference = -14.79; CI = -18.47 to -11.11; I² = 87.1%); the proportion of women cured of any urinary incontinence was 59% (95% CI = 51 to 66%) and the proportion of women cured of stress urinary incontinence was 55% (95% CI = 40 to 70%).

CONCLUSIONS

Bariatric surgery results in clinically meaningful improvements in incontinence-specific quality of life. Current data are limited by both short-term follow-up and unexplained heterogeneity among studies.

Effects of bariatric surgery on urinary incontinence

Introduction

Obesity is an important modifiable etiological factor associated with several diseases. There is strong evidence that urinary incontinence (UI) is positively correlated with body mass index (BMI).

Aim

One of the many benefits experienced by obese patients after bariatric surgery is decrease in UI. To investigate this correlation, we aimed to examine the effects of weight loss on UI in female patients who had undergone laparoscopic sleeve gastrectomy (LSG).

Materials and methods

Obese female patients (n=120), ≥18 years of age, and planning to undergo LSG were included in this prospective study. We administered the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and Incontinence Impact Questionnaire (IIQ-7) to the patients prior to surgery and 6 months after the surgery. Using the collected data, we determined the incidence of UI and examined the relationship between the preoperative and postoperative BMI and UI values.

Results

The mean age of the patients was 39.19 (standard deviation [SD] =9.94) years and the mean preoperative BMI was 46.17 (SD =5.35). Of the 120 patients, 72 (60%) complained of UI preoperatively. Among these 72 patients, 23 (31.95%) described urge incontinence, 18 (25%) stress incontinence, and 31 (43.05%) mixed-type incontinence. At 6 months postoperatively, the percentage of excess weight loss was 70.33% (SD =14.84%). For all three UI subtypes, the 6-month postoperative ICIQ-UI-SF and IIQ-7 scores decreased significantly compared to the preoperative scores (P<0.05).

Conclusion

LSG results in a clinically significant improvement in most common types of UI, regardless of patient reproductive history, existence of comorbid conditions, and smoking status.

Long-term pharmacotherapy considerations in the bariatric surgery patient

PURPOSE

Pharmacists' role in optimizing long-term pharmacotherapy for bariatric surgery patients is detailed.

SUMMARY

Bariatric surgery patients provide a difficult challenge in terms of many pharmacotherapy issues, especially in the chronic care setting, where data on long-term effects of bariatric surgery are limited. The most common procedures are Roux-en-Y gastric bypass (RYGB), adjustable gastric banding, and sleeve gastrectomy. Sleeve gastrectomy has become the most common procedure in the United States, primarily because it has less overall chronic malabsorption effects than RYGB. Pharmacotherapy management is complicated by rapid weight loss combined with a number of pharmacokinetic changes, such as decreased absorption of some medications due to altered gastrointestinal tract anatomy and potentially increased concentrations of some medications due to a decreased volume of distribution resulting from weight loss. Nutritional and metabolic supplementation are of the utmost importance in order to limit deficiencies that can lead to a number of conditions. Many chronic diseases, including hypertension, diabetes, gastroesophageal reflux disease, and urinary incontinence, are improved by bariatric surgery but require close monitoring to ensure the effectiveness of maintenance pharmacotherapy and avoidance of adverse effects. Psychotropic medication management is also an important pharmacotherapy concern, as evidenced by antidepressants being the most commonly used medication class among preoperative bariatric surgery patients.

CONCLUSION

Pharmacists have an increasing role in the chronic management of the bariatric surgery patient due to their knowledge of medication dosage forms and expertise in disease states affected by bariatric surgery.

Bariatric surgery improves female pelvic floor disorders

OBJECTIVES

Obesity aggravates pelvic floor disorders in women. Weight loss improves these disorders. The purpose of this study was to assess the evolution of pelvic floor disorders in women who have undergone bariatric surgery.

PATIENTS AND METHODS

A prospective single-center study was conducted from December 2012 to February 2014. The parameters studied were diabetes, BMI, excess weight loss, multiparity, mode of delivery and their relation to obesity and pelvic floor disorders. We evaluated anorectal and urethral sphincter disorders using the PFDI-20 questionnaire preoperatively, at 1 month and then every 6 months thereafter.

RESULTS

One hundred and sixteen patients underwent bariatric surgery. Seventy questionnaires were completed preoperatively and postoperatively. Weight loss was significant with an excess weight loss of 57.1%. The mean body mass index (BMI) decreased from 44.5 ± 6.31 kg/m(2) (range: 35.0-63.23) to 31.83 ± 5.83 kg/m(2) (range: 20.9-49.6). The average length of follow-up was 11.3 ± 5.2 months (range: 5-25). The incidence of urinary symptoms improved after surgery (P=0.003), as did the UDI-6 score (Urogenital distress inventory) (P=0.009). There was no improvement in other symptoms such as prolapse and colorectal-anal dysfunction.

CONCLUSION

The prevalence of pelvic floor disorders is high among obese women; in this study, colorectal disorders were present in 53% and urinary disorders in 71.5%. Bariatric surgery-induced weight loss led to improvement in urinary continence disorders when assessed over an average follow-up of 11 months.