Impact of bariatric surgery in patients with stress urinary incontinence

Abstract

Objective: To examine epidemiologic, anthropometric and clinical variables associated with stress urinary incontinence in obese women, before and after bariatric surgery, and to identify predictive factors of stress urinary incontinence resolution. Methods: Prospective observational study with women enrolled in a bariatric surgery program between 2015 and 2016. Patients were assessed prior to and 6 months after bariatric surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale. Patient assessment also included physical examination and bladder stress tests. Results: A total of 43 women completed the study. There was a 72.7% reduction in stress urinary incontinence (p=0.021). Predictive factors for preoperative diagnosis of stress urinary incontinence included age (p=0.024) and abdominal waist circumference (p=0.048). Urinary symptoms improved after weight loss, especially nocturia (p=0.001) and stress urinary incontinence (p=0.026). Menopause was the most significant predictive factor for persistence of stress urinary incontinence within six months of bariatric surgery (p=0.046). Self-reported outcomes and scores obtained in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale were associated with significant improvement (p=0.012, p=0.025, and p=0.002 respectively). Conclusion: Older women with larger waist circumference have a higher risk of developing stress urinary incontinence prior to bariatric surgery. Menopausal women are highly prone to persistent stress urinary incontinence, even after weight loss. Weight loss achieved through bariatric surgery improved stress urinary incontinence symptoms and mitigated related impacts on quality of life in the vast majority of women.

Summarizing Consensus Guidelines on Obesity Management

“…Much of the diminished general health and life quality that individuals living with obesity experience stems from this extensive array of comorbid health conditions that influence virtually every organ system and both physical and psychological health. Besides T2DM, cardiovascular disease, sleep apnea, renal disease and cancer, such conditions include metabolic syndrome, 24,25 liver disease, 26–28 gallbladder disease, 29,30 pancreatitis, 29,30 venous thromboemboli, 31 urinary stress incontinence, 32,33 idiopathic intracranial hypertension, 34,35 osteoarthritis, 36 and psychiatric disorders like depression and anxiety 37–41 . It is crucial that such conditions are recognized for several reasons that include (a) their potential for severe and even life-threatening consequences, and (b) how many of these conditions, including diabetes and cardiovascular disease, have been documented to improve or even abate altogether following successful metabolic and bariatric surgery (MBS) or bariatric endoscopy.…”