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Valipour R, Narouie B, Dadpour M, Torabinavid P, Momeni H, Radpour N, Ahmadzade M, Rouientan H, Danesh H, Emami MA. Impacts of Bariatric Surgery on Improvement of Incontinence Among Obese Asian Women: A Prospective Study and Literature Review. Obes Surg 2024; 34:1425-1431. [PMID: 38517646 DOI: 10.1007/s11695-024-07172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Limited studies investigate bariatric surgery's role in improving UI status among Asians, specifically Middle Eastern Asian women. The aim of this study is to investigate the effect of bariatric surgery on the three most prevalent urine incontinence (UI).We also reviewed the current literature exploring the studies performed in Asian countries. MATERIALS AND METHODS A total of 77 women out of 200 who had UI and indications for bariatric surgery completed demographic information and the questionnaire (QUID) prior to surgery and 6 months after the surgery. For statistical analysis, the Mann-Whitney U test, Wilcoxon test, and Friedman test were utilized. We also performed a literature review with the aim of investigating studies performed in Asian countries. RESULTS Among the initial analysis of 200 participants, 50.5% reported UI symptoms before surgery. The average weight loss was 29 kg, with a standard deviation of 7 kg. The mean BMI dropped 11.2 kg/m2, and the standard deviation was 2.5 after weight loss. Post-surgery, significant reductions in UI scores were observed across all severity levels, with a notable 44% achieving complete symptom resolution, indicating a substantial decrease in urinary incontinence. Stress, urine incontinence, and mixed urine incontinence symptoms had improved in 75%, 71%, and 30% of women, respectively. Notably, age and gynecological history were identified as critical factors influencing the extent of UI improvement. CONCLUSION This study reveals significant improvements in urinary incontinence scores, with age and gynecological history playing pivotal roles in UI improvement.
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Affiliation(s)
- Reza Valipour
- Department of Urology, Tehran Medical Sciences Branch, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Mehdi Dadpour
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parham Torabinavid
- Department of Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Science, Tehran, Iran
| | - Hamidreza Momeni
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Radpour
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadese Ahmadzade
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Rouientan
- Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hoseinali Danesh
- Department of Surgery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Aref Emami
- Department of Surgery, Zahedan University of Medical Sciences, Zahedan, Iran
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Güneş Y, Fersahoğlu MM, Bulut NE, Çakmak A, Ergin A, Teke E, Karataş TC, Şahin A, Sancak S. Effects of Sleeve Gastrectomy on Pelvic Floor Disorders in Female Patients with Severe Obesity: a Prospective Study. Obes Surg 2023; 33:3069-3076. [PMID: 37428362 DOI: 10.1007/s11695-023-06725-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Obesity is associated with pelvic floor disorders (PFD). Sleeve gastrectomy (SG) is one of the most effective weight loss methods. Although SG has been found to improve urinary incontinence (UI) and overactive bladder (OAB), its impact on fecal incontinence (FI) remains controversial. MATERIALS AND METHODS This prospective, randomized study involved 60 female patients with severe obesity who were randomly assigned to two groups: the SG group and the diet group. The SG group underwent SG, while the diet group received a low-calorie, low-lipid diet for 6 months. The patients' condition was assessed before and after the study using three questionnaires: the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), the Overactive Bladder 8-Question Awareness Tool (OAB-V8), and the Wexner Score (CCIS). RESULTS After 6 months, the SG group had a significantly higher percentage of total weight loss (%TWL) compared to the diet group (p<0.01). Both groups showed a decrease in the ICIQ-FLUTS, OAB-V8, and CCIS scores (p<0.05). UI, OAB, and FI improved significantly in the SG group (p<0.05), but no improvement was observed in the diet group (p>0.05). The correlation between %TWL and PFD was statistically significant but weak, with the strongest correlation between %TWL and ICIQ-FLUTS score and the weakest correlation between %TWL and CCIS score (p<0.05). CONCLUSIONS We recommend bariatric surgery for the treatment of PFD. However, given the weak correlation between %TWL and PFD after SG, further research should explore factors other than %TWL that are effective in recovery, particularly in relation to FI.
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Affiliation(s)
- Yasin Güneş
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey.
| | - Mehmet Mahir Fersahoğlu
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Nuriye Esen Bulut
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Ahmet Çakmak
- Department of General Surgery, Sinop Atatürk State Hospital, 57000, Sinop, Turkey
| | - Anıl Ergin
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Emre Teke
- Department of General Surgery, Haydarpaşa Numune Training And Research Hospital, Tıbbiye Cad. No: 23 Üsküdar, 34668, Istanbul, Turkey
| | - Tuğba Caner Karataş
- Department of General Surgery, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Aytaç Şahin
- Department of Urology, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
| | - Seda Sancak
- Department of Internal Medicine/Endocrinology and Metabolism Disorders, Fatih Sultan Mehmet Training And Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8 Ataşehir, 34752, Istanbul, Turkey
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Impact of bariatric surgery on urinary incontinence in morbidly obese individuals. Surg Endosc 2021; 36:4771-4779. [PMID: 34741207 DOI: 10.1007/s00464-021-08818-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is scanty evidence on the impact of bariatric surgery on urinary incontinence (UI) in the Asian population. METHODOLOGY Patients who underwent bariatric surgery from June 2018 to June 2019 were screened using the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) questionnaire. Patients having UI were identified and followed until 1 year of surgery using the ICIQ-UI-SF. These were classified as having stress, urge, or mixed type of UI. The prevalence, change in scores, and the number of pads used were compared at baseline and at follow-up. RESULTS A total of 148 patients underwent bariatric surgery of whom, 41 patients (M = 2, F = 39) had UI. Stress incontinence was seen in 70.7%, 19.5% had urge incontinence, and rest had the mixed type. Using logistic regression, it was found that female gender was the most important predictor of having UI (OR: 8.33). The prevalence of UI decreased from 27.7% at baseline to 8.1% at 6 months and 3.4% at 12 months. The mean ICIQ-UI-SF score improved from 8.76 (SD = 3.2) at baseline to 0.66 (SD = 2.1) at 12 months of follow-up. The proportion of patients with UI using any number of pads decreased from 92.7% at baseline to 9.8% at 12 months. There was a decrease in the number of patients having moderate to very severe UI from 35 (85.4%) at baseline to 2 (4.9%) at 12 months. Proportion of patients showing resolution was highest among the stress incontinence group at 96.5%. Presence or absence of comorbidities did not significantly influence the ICIQ-UI-SF scores. CONCLUSION Bariatric surgery leads to profound improvement in UI in obese individuals which is well sustained until 1 year of follow-up. Resolution rates might be higher in Asian population.
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Sheridan W, Da Silva AS, Leca BM, Ostarijas E, Patel AG, Aylwin SJ, Vincent RP, Panagiotopoulos S, El-Hasani S, le Roux CW, Miras AD, Cardozo L, Dimitriadis GK. Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis. Clin Obes 2021; 11:e12450. [PMID: 33955687 DOI: 10.1111/cob.12450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Women with obesity are at risk of pelvic floor dysfunction with a 3-fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index ≥30 kg/m2 should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta-analysis will assess this recommendation to aid in the counselling of women with obesity-related urinary incontinence (UI). Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov, and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence. Thirty-three studies and their outcomes were meta-analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI-20, SMD -0.774 (95% CI [-1.236, -0.312]). This systematic review and meta-analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity-related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomized control trials assessing the effect of bariatric surgery on women with obesity-related UI are needed to confirm this study's findings.
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Affiliation(s)
- William Sheridan
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Ana Sofia Da Silva
- Department of Urogynaecology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Bianca M Leca
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Eduard Ostarijas
- Institute for Translational Medicine, University of Pecs Medical School, Pécs, Hungary
| | - Ameet G Patel
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Simon Jb Aylwin
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Royce P Vincent
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Spyros Panagiotopoulos
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Shamsi El-Hasani
- Minimal Access and Bariatric Unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Orpington, UK
| | - Carel W le Roux
- Diabetes Complication Research Centre, School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Belfield, Ireland
| | - Alexander D Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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Barco-Castillo C, Plata M, Zuluaga L, Serrano A, Gómez A, Santander J, Caicedo JI, Azuero J, Echeverry M, Trujillo CG. Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis. Neurourol Urodyn 2020; 39:2153-2160. [PMID: 32794648 DOI: 10.1002/nau.24459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/11/2020] [Accepted: 07/08/2020] [Indexed: 11/12/2022]
Abstract
PURPOSE Obesity is one of the main risk factors for stress urinary incontinence (SUI) and has also been associated with worse surgical outcomes. However, the literature is heterogeneous and inconclusive. The goal of this study was to perform a systematic review and meta-analysis to evaluate cure rates and perioperative complications in obese women. MATERIALS AND METHODS A literature search of OVID, MEDNAR, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases was conducted. Randomized controlled trials comparing cure rates and failure of treatment in normal and obese patients, who underwent mid-urethral sling surgery, were identified. A systematic review of subjective and objective cure rates, and complications was performed. Meta-analyses of dichotomous data under the random-effects model were applied using Review Manager 5.3. Nonrandomized comparative studies and gray literature were excluded. RESULTS A total of 219 studies were identified. Four randomized controlled trials were included for evaluation. The risk of bias evaluation was performed according to the Cochrane Handbook for Systematic Reviews of Interventions. One study was excluded due to missing data on the outcomes. Patients were stratified according to their body mass index as obese (>30 kg/m2 ) and nonobese (<30 kg/m2 ). Complications could not be meta-analyzed. The meta-analysis of subjective (risk ratio [RR] = 1.69 [95% confidence interval [CI]: 1.32-2.16]) and objective (RR = 1.62 [95% CI: 1.26-2.07]) cure rates disfavored obese women. CONCLUSIONS This meta-analysis shows that obesity is a risk factor for the nonsuccessful treatment of SUI with tension-free mid-urethral sling. Differences in regards to the surgical approach and its association with obesity could not be established with the current evidence.
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Affiliation(s)
- Catalina Barco-Castillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Adolfo Serrano
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Andrea Gómez
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Jessica Santander
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Juan I Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Julián Azuero
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Mariana Echeverry
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia.,School of Medicine, Universidad de los Andes School of Medicine, Bogotá DC, Colombia
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American Urogynecologic Society Systematic Review: The Impact of Weight Loss Intervention on Lower Urinary Tract Symptoms and Urinary Incontinence in Overweight and Obese Women. Female Pelvic Med Reconstr Surg 2020; 26:16-29. [DOI: 10.1097/spv.0000000000000802] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lee Y, Yu J, Tikkinen KA, Pędziwiatr M, Major P, Aditya I, Krakowsky Y, Doumouras AG, Gmora S, Anvari M, Hong D. The impact of bariatric surgery on urinary incontinence: a systematic review and meta-analysis. BJU Int 2019; 124:917-934. [DOI: 10.1111/bju.14829] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Yung Lee
- Michael G. DeGroote School of Medicine; McMaster University; Hamilton ON Canada
- Division of General Surgery; Department of Surgery; McMaster University; Hamilton ON Canada
- Centre for Minimal Access Surgery (CMAS); St. Joseph's Healthcare; McMaster University; Hamilton ON Canada
| | - James Yu
- Division of General Surgery; Department of Surgery; McMaster University; Hamilton ON Canada
- Centre for Minimal Access Surgery (CMAS); St. Joseph's Healthcare; McMaster University; Hamilton ON Canada
| | - Kari A.O. Tikkinen
- Departments of Urology and Public Health; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery; Jagiellonian University; Krakow Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery); Krakow Poland
| | - Piotr Major
- 2nd Department of General Surgery; Jagiellonian University; Krakow Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery); Krakow Poland
| | - Ishan Aditya
- Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - Yonah Krakowsky
- Division of Urology; Department of Surgery; Women's College Hospital and Sinai Health System; University of Toronto; Toronto ON Canada
| | - Aristithes G. Doumouras
- Division of General Surgery; Department of Surgery; McMaster University; Hamilton ON Canada
- Centre for Minimal Access Surgery (CMAS); St. Joseph's Healthcare; McMaster University; Hamilton ON Canada
| | - Scott Gmora
- Division of General Surgery; Department of Surgery; McMaster University; Hamilton ON Canada
- Centre for Minimal Access Surgery (CMAS); St. Joseph's Healthcare; McMaster University; Hamilton ON Canada
| | - Mehran Anvari
- Division of General Surgery; Department of Surgery; McMaster University; Hamilton ON Canada
- Centre for Minimal Access Surgery (CMAS); St. Joseph's Healthcare; McMaster University; Hamilton ON Canada
| | - Dennis Hong
- Division of General Surgery; Department of Surgery; McMaster University; Hamilton ON Canada
- Centre for Minimal Access Surgery (CMAS); St. Joseph's Healthcare; McMaster University; Hamilton ON Canada
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Montenegro M, Slongo H, Juliato CRT, Minassian VA, Tavakkoli A, Brito LGO. The Impact of Bariatric Surgery on Pelvic Floor Dysfunction: A Systematic Review. J Minim Invasive Gynecol 2019; 26:816-825. [PMID: 30708118 DOI: 10.1016/j.jmig.2019.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/02/2019] [Accepted: 01/20/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the effect of bariatric surgery (BS) on the prevalence of pelvic floor dysfunctions (PFD), specifically on urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI). DATA SOURCES A systematic review (PROSPERO registration no. CRD42017068452) with a literature search was performed using the PubMed, Scopus, and SciELO databases for all publications related to BS and PFD, with no language restrictions, from inception to September 2018. METHODS OF STUDY SELECTION Two authors screened for study eligibility and extracted data. Only prospective cohorts assessing women with morbid obesity and the prevalence of PFD before and after BS in multiple academic and private centers were included. UI, POP, and FI were defined according to the International Urogynecological Association/International Continence Society joint consensus, and diagnosis was made based on self-report or questionnaires. TABULATION, INTEGRATION, AND RESULTS Our search strategy retrieved 957 results. Of those, 28 studies were included for full analysis, and 20 studies (n = 3684 patients) were selected for final analysis. The main reasons for exclusion were missing data before and after BS (n = 7) and combined data of men and women who underwent BS (n = 1). Laparoscopic Roux-en-Y gastric bypass was the most common surgical technique. Pooled analysis (16 studies) showed that women had a mean body mass index reduction of 12.90 kg/m2 after treatment (95% confidence interval [CI], -14.82 to -10.97; p < .0001). The relative risk reduction was 67% (n = 19; odds ratio [OR], 0.33; 95% CI, 0.26-0.41; p < .0001) for UI, 52% (n = 5; OR, 0.48; 95% CI, 0.22-1.07; p = .07) for POP, and 20% (n = 9; OR, 0.80; 95% CI, 0.53-1.21; p = .29) for FI. Funnel plots for UI and FI did not suggest any publication bias. With regard to the standardized questionnaires for PFD, the International Consultation on Incontinence-Short Form, Pelvic Floor Impact Questionnaire-7 and its subscale Colorectal-Anal Impact Questionnaire-7, Pelvic Floor Distress Inventory-20, and its subscale Urinary Distress Inventory-6 showed statistically significantly lower scores. Sexual function, represented by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, showed no statistically significant improvement after surgery. CONCLUSION BS has a significant impact on reducing UI, but FI and POP, in obese women.
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Affiliation(s)
- Marcelo Montenegro
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil (Drs. Montenegro, Slongo, Juliato, and Brito)
| | - Helena Slongo
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil (Drs. Montenegro, Slongo, Juliato, and Brito)
| | - Cassia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil (Drs. Montenegro, Slongo, Juliato, and Brito)
| | - Vatche Arakel Minassian
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA (Dr. Minassian)
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Tavakkoli)
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, SP, Brazil (Drs. Montenegro, Slongo, Juliato, and Brito).
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Pazzianotto-Forti EM, Brigatto P, Baltieri L, Souza Júnior JED, Guirro ECDO, Kasawara KT. Quality of life in obese women with symptoms of urinary incontinence. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Obesity is a contributing factor to the development of urinary incontinence (UI). Objective: The objective of this study was to evaluate the prevalence of UI symptoms in women with morbid obesity and their impacts on quality of life (QOL), correlating the influence of age and body mass index (BMI) with the presence of UI. Method: Sixty-five women undergoing preoperative bariatric surgery, aged 35.8 ± 9.97 years, with an average BMI of 45.04 ± 6.79 kg/m2 were asked about the presence of UI symptoms; when they answered positively, the King’s Health Questionnaire (validated into Portuguese) was applied. The questionnaire was self-administered and all answers were assigned numerical scores. These scores were distributed according to quartiles and correlated with age and BMI. The level of hypothesis rejection was 5%, and analyses were performed using BioEstat software version 5.3. Results: Among 65 interviewees, 19 (29.23%) had symptoms of UI and went on to answer the questionnaire. The highest-scoring areas were “incontinence impact” (36.8) and “general health perception” (32.9). There was no significant correlation between questionnaire scores and BMI. In the association with age, the “incontinence impact” domain showed a significant, positive and moderate correlation (r = 0.52; p = 0.02). Conclusion: The prevalence of UI symptoms in the sample had a slight negative effect on QOL; however, UI associated with older ages significantly affected the QOL of the studied volunteers.
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The long-term effects of bariatric surgery on female urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2018; 231:15-18. [DOI: 10.1016/j.ejogrb.2018.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/12/2018] [Accepted: 10/02/2018] [Indexed: 11/23/2022]
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Effect of Bariatric Surgery on Urinary Incontinence in Obese Women: A Meta-analysis and Systematic Review. Female Pelvic Med Reconstr Surg 2018; 26:207-211. [PMID: 30180048 DOI: 10.1097/spv.0000000000000631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study was to explore the effectiveness of bariatric surgery in obese women with urinary incontinence (UI) through meta-analysis. METHODS Searches of PubMed, the Cochrane Library, and EMBASE databases were performed using "weight loss surgery/bariatric surgery/gastric bypass surgery" and "incontinentia urinae/uracratia/urinary incontinence/uroclepsia" in the title/abstract before January 2018. Then, meta-analysis was analyzed by Review Manager 5.3 (Cochrane Collaboration, Oxford, United Kingdom). The standardized mean difference (SMD) and odds ratio (OR) were used to describe results of continuous variables and dichotomous variables, respectively. RESULTS Pooled data showed that bariatric surgery reduced the incidence of UI in obese women at the follow-up of 6 months (OR, 3.27; 95% confidence interval [CI], 2.55-4.21; P < 0.00001) and 12 months (OR, 4.04; 95% CI, 2.62-6.22; P < 0.00001) and significantly reduced the body mass index at 6 months (SMD, 1.86; 95% CI, 1.19-2.53; P < 0.00001) and 12 months (SMD, 2.04; 95% CI, 1.44-2.64; P < 0.00001). In addition, bariatric surgery could also significantly increase the quality of life (SMD, 0.53; 95% CI, 0.27-0.80; P < 0.00001) and improve the function of pelvic floor disorders (SMD, 0.55; 95% CI, 0.38-0.72; P < 0.00001) based on quality-of-life questionnaires and Pelvic Floor Distress Inventory 20, respectively. CONCLUSIONS This meta-analysis demonstrated that bariatric surgery is an effective choice for obese women with UI. However, more randomized controlled trials are required to confirm this result.
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Fuselier A, Hanberry J, Margaret Lovin J, Gomelsky A. Obesity and Stress Urinary Incontinence: Impact on Pathophysiology and Treatment. Curr Urol Rep 2018; 19:10. [PMID: 29468457 DOI: 10.1007/s11934-018-0762-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Obesity is highly prevalent and is associated with stress urinary incontinence (SUI). The purposes of this review are to assess the pathophysiology of SUI in the obese female and review the outcomes of weight loss and anti-incontinence surgery in this population. RECENT FINDINGS While increased intra-abdominal pressure appears to be the common pathophysiologic link between obesity and SUI, neurogenic and metabolic pathways have been proposed. Both surgical and non-surgical weight loss continue to have beneficial effects on SUI; however, long-term outcomes are largely absent. Midurethral sling (MUS) surgery is largely effective in the obese population, with a complication profile similar to that in non-obese women. Obesity has been shown to be a risk factor for failure of MUS. While weight loss should be the primary modality to improve SUI in the obese woman, MUS remains an effective and safe option in those women undertaking surgery.
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Affiliation(s)
- Alex Fuselier
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - Jordan Hanberry
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - J Margaret Lovin
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA
| | - Alex Gomelsky
- Department of Urology, Louisiana State University Health-Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA.
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