Abstract
ABSTRACTObjective: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.
Highlights
Stress urinary incontinence (SUI) is a prevalent disease
Weight loss is a therapeutic intervention for patients with SUI.[3]. Low-calorie diets may result in weight loss and improve SUI symptoms in obese women.[9]. Likewise, SUI improves in response to weight loss following bariatric surgery.[4,10,11] Obese patients tend to experience a 53 to 56% reduction in body mass index (BMI) within six months of bariatric surgery and may lose up to 74% of their initial body weight within two years.[12]
Weight loss is a well-established therapeutic approach for SUI and is recommended as a feasible and interesting strategy for these women.[3]. Previous studies have shown that modest (5% to 10%) weight loss translates into significant benefits for obese women with urinary incontinence.[9]. Women in this cohort experienced a weight loss of 25.1% in the first 6 months after bariatric surgery
Summary
Stress urinary incontinence (SUI) is a prevalent disease. SUI was estimated to affect 30 million adults in the United States, with a prevalence of 54% in women and 15% in men.[1] Stress urinary incontinence is a global health problem with considerable social and economic impacts, which affects patient quality of life and reduces productivity, leading to social isolation and depression.[2]. Obesity is a known risk factor for SUI. Five-unit increments of body mass index (BMI) were associated with a 30% increase in severe urinary incontinence,(3-5) especially SUI.[6,7,8]. Given obesity is a modifiable risk factor, weight loss within healthy limits may reduce SUI. SUI improves in response to weight loss following bariatric surgery.[4,10,11] Obese patients tend to experience a 53 to 56% reduction in BMI within six months of bariatric surgery and may lose up to 74% of their initial body weight within two years.[12]
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