Presentation Authors: Yung Lee, James Yu, Hamilton, Canada, Michał Pędziwiatr, Piotr Major, Krakow, Poland, Ishan Aditya*, Toronto, Canada, Kari Tikkinen, Helsinki, Finland, Yonah Krakowsky, Toronto, Canada, Aristithes Doumouras, Scott Gmora, Mehran Anvari, Dennis Hong, Hamilton, Canada
Introduction: Obesity is a major risk factor for urinary incontinence (UI). For treating UI in obese patients, current guidelines recommend weight loss through lifestyle interventions. However, the role of sustained weight loss induced by bariatric surgery for the treatment of UI in obese patients remains unclear. We aimed to conduct a systematic review and meta-analysis to critically evaluate the effect of bariatric surgery on UI in obese patients.
Methods: We searched Medline, EMBASE, CENTRAL, PubMed, and relevant major conference abstracts up to June 2018, including any studies that compared UI status in obese patients before and after bariatric surgery. Primary outcomes were improvement or complete resolution of stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) before and after surgery. Secondary outcomes were validated urinary incontinence questionnaires: urogenital distress inventory (UDI-6), International Consultation on Incontinence Questionnaire (ICIQ), and Incontinence Impact Questionnaire (IIQ) before and after surgery. Pooled estimates were calculated using random-effects or proportions meta-analysis and heterogeneity was quantified using the I2 statistic. Two reviewers independently reviewed the studies, collected data, assessed risk of bias, and conducted Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) to assess quality of evidence.
Results: 35 cohort studies involving a total of 9,250 obese patients (90.8% female) met the inclusion criteria with a median follow up of 15 months after surgery (range, 6 to 60 months). The weighted mean BMI at baseline was 45.7+/-6.9 kg/m2 and 32.2+/-5.9 kg/m2 at follow-up, with an relative reduction of 29.7% after bariatric surgery. Bariatric surgery resulted in improvement or resolution of any UI in 58% (95% CI, 50-65%), SUI in 47% (95% CI, 34-60%), and UUI in 37% of patients (95%CI, 15-62%). Moreover, bariatric surgery significantly decreased UDI-6 scores by 14.7 points (95% CI, 9.6-19.7, P < 0.001), ICIQ score by 4.5 points (95% CI, 2.9-6.0, P < 0.001), and IIQ scores by 5.3 (95% CI, 3.9-6.6, P < 0.001) after surgery. Conversely, 3% (95% CI, 0-13%) of patients experienced worsening or new onset of UI after bariatric surgery. All meta-analysed outcomes had high heterogeneity (I2>50%).
Conclusions: Bariatric surgery leads to improvement or resolution of SUI in half and of UUI in more than one-third of obese patients. Large scale comparative studies are warranted to further examine the benefits and harms of bariatric surgery as treatment for UI.