Abstract:IMPORTANCE Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking.OBJECTIVES To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery.
DESIGN, SETTING, AND PARTICIPANTSThe Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study … Show more
“…Subak et al found that weight loss after bariatric surgery was associated with substantially decreased urinary incontinence during 3 years. 13 Further research is needed of the role of weight loss in UUI refractory to treatment.…”
Purpose: We sought to identify clinical and demographic characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation therapies. Materials and Methods: We analyzed data from the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation versus BoTulinum Toxin Assessment) trial. Baseline participant characteristics and clinical variables were associated with 2 definitions of treatment response, including 1) a reduction in mean daily urgency incontinence episodes during 6 months and 2) a 50% or greater decrease in urgency incontinence episodes across 6 months. The OAB-S (Overactive Bladder-Satisfaction) questionnaire was used to assess satisfaction. Results: A greater reduction in mean daily urgency incontinence episodes was associated with higher HUI-3 (Health Utility Index-3) scores in the onabotulinumtoxinA group and higher baseline incontinence episodes (each p <0.001) in the 2 groups. Increased age was associated with a lesser decrease in incontinence episodes in the 2 groups (p <0.001). Increasing body mass index (adjusted OR 0.82/5 points, 95% CI 0.70e0.96) was associated with reduced achievement of a 50% or greater decrease in incontinence episodes after each treatment. Greater age (adjusted OR 0.44/10 years, 95% CI 0.30e0.65) and a higher functional comorbidity index (adjusted OR 0.84/1 point, 95% CI 0.71e0.99) were associated with reduced achievement of a 50% or greater decrease in urgency incontinence episodes in the onabotulinumtoxinA group only (p <0.001 and 0.041, Accepted for publication April 27, 2017. No direct or indirect commercial incentive associated with publishing this article. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number.
“…Subak et al found that weight loss after bariatric surgery was associated with substantially decreased urinary incontinence during 3 years. 13 Further research is needed of the role of weight loss in UUI refractory to treatment.…”
Purpose: We sought to identify clinical and demographic characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation therapies. Materials and Methods: We analyzed data from the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation versus BoTulinum Toxin Assessment) trial. Baseline participant characteristics and clinical variables were associated with 2 definitions of treatment response, including 1) a reduction in mean daily urgency incontinence episodes during 6 months and 2) a 50% or greater decrease in urgency incontinence episodes across 6 months. The OAB-S (Overactive Bladder-Satisfaction) questionnaire was used to assess satisfaction. Results: A greater reduction in mean daily urgency incontinence episodes was associated with higher HUI-3 (Health Utility Index-3) scores in the onabotulinumtoxinA group and higher baseline incontinence episodes (each p <0.001) in the 2 groups. Increased age was associated with a lesser decrease in incontinence episodes in the 2 groups (p <0.001). Increasing body mass index (adjusted OR 0.82/5 points, 95% CI 0.70e0.96) was associated with reduced achievement of a 50% or greater decrease in incontinence episodes after each treatment. Greater age (adjusted OR 0.44/10 years, 95% CI 0.30e0.65) and a higher functional comorbidity index (adjusted OR 0.84/1 point, 95% CI 0.71e0.99) were associated with reduced achievement of a 50% or greater decrease in urgency incontinence episodes in the onabotulinumtoxinA group only (p <0.001 and 0.041, Accepted for publication April 27, 2017. No direct or indirect commercial incentive associated with publishing this article. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number.
“…In addition, female UI is also related with other factors such as parity, type of delivery, previous hormone therapy and urogenital surgery, constipation, existence of pelvic floor disorders or other chronic diseases [29,31,[38][39][40]. Non-surgical weight loss interventions (diet, exercise or a combination of both) may improve female UI [41] and recently it has been shown that under extreme obese conditions, bariatric surgery has been proposed to improve urinary continence [42].…”
“…The investigators of the Longitudinal Assessment of Bariatric Surgery 2 recently published their 3 year follow-up data. 68 Prevalent UI, defined as at least weekly UI episodes, was 49.3% at baseline in the women, 18.3% at 1 year (mean weight loss 29.5%), and 24.8% at 3 years. Similar optimistic findings were reported by the investigators of the Program to Reduce Incontinence by Diet and Exercise (PRIDE), even with modest weight loss defined as 5–10% of body weight.…”
Section: Phase Iii: Intervening Factors For Pelvic Floor Disordersmentioning
SYNOPSIS
Using a life span model, this article presents new scientific findings regarding risk factors for pelvic floor disorders (PFDs), with a focus on the role of childbirth in the development of single or multiple co-existing PFDs. Phase I of the life span model includes predisposing factors such as genetic predisposition and race. Phase II of the model includes inciting factors such as obstetric events. Prolapse, urinary incontinence (UI) and fecal incontinence (FI) are more common among vaginally parous women, although the impact of vaginal delivery on risk of FI is less dramatic than for prolapse and UI. Finally, Phase III includes intervening factors such as age and obesity. Both age and obesity are associated with prevalence of PFDs. The prevention and treatment of obesity is an important component to PFD prevention.
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