Bariatric surgery is able to cure urinary incontinence in one of three women with obesity and a significant improvement was obtained in more than two-thirds of the patients, regardless of the type of incontinence, according to researchers from “Carol Davila” University of Medicine and Pharmacy, in Bucharest, Romania.
Surgery is still the basis for treating SUI, whether it be through the insertion of a midurethral sling, Burch colposuspension, pubovaginal sling using autologous rectus fascia or the use of a bulking agent. However, women with a BMI over 35 kg/m2 have a relatively high failure rate for this procedure: 81% of them manage to gain and maintain continence, compared to 92% to 96% of the general population.
Given the fact that it is proven that weight loss is beneficial for improving symptoms of UI, the researchers assessed whether bariatric surgery could lead to similar benefits. They conducted a prospective study on female patients with obesity and with symptoms of urinary incontinence, comparing data before and after bariatric surgery over a period of nine years.
The study included female patients that simultaneously met the bariatric surgery criteria and described involuntary loss of urine at least two or three times a week, and had no previous history of surgery for urinary incontinence.
During the urological evaluation, they assessed comprehensive medical history regarding UI symptoms. A full clinical examination was performed for each patient. For the purpose of this study, it was decided upfront to exclude patients with pelvic organ prolapse, fistulas or other malformations of the urinary tract. Patients were also required to fill in the International Consultation on Incontinence Questionnaire-Urinary Incontinence short form (ICIQ-UI SF) before and after surgery.
Outcomes
Over a period of nine years, 54 female patients with obesity and with urinary incontinence underwent bariatric surgery, with over 50% of the eligible women for bariatric surgery were suffering from urinary incontinence. The mean age for the included patients was 37.1±7.93.
At least one comorbidity was present in 33.3% (17) of patients. A total of 18.5% (10) of our sample had high blood pressure; 13% (7) were diabetic; and 31.5% (17) had dyslipidaemia. Prior to the surgery, the median BMI was 42.5 ± 3.87, and half of the women suffered from stress urinary incontinence, while 20 (37%) were found to have urge UI; 7 women (13%) had mixed UI.
After the follow-up period, they observed a significant drop in the mean BMI in all cases (42.5±3.87 vs. 30.29±4.22; p<0.005). The prevalence of stress UI decreased after the surgery (27 (50% of all the patients) vs. 16). Both the prevalence of urge UI (20 cases vs. 15 cases after surgery) and mixed UI (7 cases vs. 5 cases) decreased, yet without statistical significance. They speculated that the lack of statistical significance might be due to the relatively small sample size.
The ICIQ score improved from 13.31 ± 5.18 points before surgery to 8.30 ± 4.49 points after surgery (p < 0.0001). Before surgery, 38 patients (70%) described severe incontinence, compared to only 20 patients (37%) after surgery.
A total of 16 women (31%) reported complete cure of urinary incontinence after bariatric surgery; 12 women who suffered from SUI reported no incontinence after the surgery, while only 4 patients declared no incontinence after UUI and MUI (Table 1).
Table 1: Quality of life assessments before and after surgery
Every patient that scored 6 or above on the VAS was declared improved after the surgery. Data from the VAS questionnaire show improvement in 46 cases (85%). It is important to mention that all patients filled in at least “5” on the VAS score, so no worsening of symptoms after surgery was found. In 15% of cases (8 patients), no improvement was found during the follow-up at 18 months. Pad usage improved from 7.04±2.79 to 3.42±2.77 (p<0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%).
They analysed if age, initial BMI and the number or the method of delivery could predict a better improvement in symptoms of UI after surgery. No statistical correlation between the postoperative ICIQ-UI SF score, VAS questionnaire or cured incontinence rate and these parameters was found.
“Almost half of the patients with stress urinary incontinence declared no involuntary leak of urine after surgery. The findings of this study suggest that weight loss via bariatric surgery is an efficient method of managing stress urinary incontinence in obese women,” the authors concluded. “A larger sample is needed to demonstrate the beneficial effect on urgency urinary incontinence and mixed urinary incontinence. For an obese female with urinary incontinence, treatment for obesity should prevail and incontinence should be treated only if symptoms remain after surgery.”
The findings were reported in the paper, ‘Is Surgical Treatment for Obesity Able to Cure Urinary Incontinence in Women?—A Prospective Single-Center Study', published in MDPI.
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