The Effect of Abdominoplasty on Urinary Incontinence in Women

Abstract

Sir: Urinary incontinence has a significant psychosocial, economic, and health impact on the Australian community.1 In 2006, the prevalence of incontinence in Australian women was estimated to be as high as 37 percent1 and in 1998 was thought to cost the community $710 million in treatment and personal costs.2 Current treatments for female incontinence include pelvic floor exercises, medication, and surgery. The current literature on the effect of abdominoplasty on urinary incontinence consists of three case reports.3–5 These were all single case reports of middle-aged female patients who subjectively reported improved urologic function postoperatively. The proposed mechanism in all cases was an increase in intraabdominal pressure and muscle stabilization by plicating the rectus sheath, which facilitated improved bladder emptying. We hypothesized that women with urinary incontinence symptoms may have improvement following abdominoplasty. We performed a retrospective postal questionnaire–based study of a population of women who had undergone abdominoplasty at either Flinders Medical Centre or the private rooms of the senior author (R.G.M.) between January of 2005 and March of 2009. Any patient that had undergone previous urologic surgery was excluded. Data were also collected from the medical records. As no previously validated questionnaire existed for such a retrospective study, one was devised by the study group (Fig. 1). The questionnaire consisted of a series of questions asking the patient to grade her symptoms using a Likert scale. These questions were designed to assess symptoms of urinary incontinence before and after abdominoplasty. Results were tested for significance using the unpaired t test and the chi-square test. Patients were grouped together for the purposes of analysis.Fig. 1.: Questionnaire used in the study to assess symptoms of urinary incontinence.In our population of 100 patients who underwent abdominoplasty, the median age was 42.7 years (range, 14.2 to 77.5 years), with a mean weight of 76.0 kg (range, 40 to 120 kg) and a mean body mass index of 28.9 (range, 20.5 to 42.9). The main indication for abdominoplasty was localized adiposity (82.8 percent). The group reporting incontinence symptoms had undergone fewer cesarean deliveries (p = 0.005, t test). None of the other variables was significant. Forty-six patients replied to the questionnaire, of which 59.0 percent reported incontinence symptoms preoperatively. Of these patients, 25.9 percent reported improvement of symptoms, 3.7 percent reported worsening of symptoms, and the rest reported no change during the 6 months postoperatively (Fig. 2).Fig. 2.: Change in symptoms of urinary incontinence during the first 6 months postoperatively.This study was conducted in a population of middle-aged women with medium to high body mass indexes who underwent abdominoplasty for mainly aesthetic reasons. The majority of these patients had previously had children, and a number had undergone significant weight loss. This is a population already known to have a high rate of urinary incontinence. The key finding of our study was that 25.9 percent of patients undergoing abdominoplasty who had symptoms of urinary incontinence reported an improvement in these symptoms postoperatively. The strength of this study is affected by several drawbacks, which include the use of a nonvalidated questionnaire, a small population size, and the retrospective nature of the study. However, despite this, it still indicates that abdominoplasty may have a beneficial effect on the symptoms of urinary incontinence in this population, and it is a field worthy of further prospective study. DISCLOSURE The authors have no conflicts of interest to disclose. Nicholas S. Solanki, B.M.B.S., B.Sc. Jaime A. Duffield, Ph.D., B.Sc.(Hons.) Nicola R. Dean, F.R.C.S.(Eng.), Ph.D. R. Gwyn Morgan, F.R.C.S., F.A.C.S. Department of Plastic and Reconstructive Surgery Flinders Medical Centre Bedford Park, South Australia, Australia