Obesity surgery cures urinary incontinence in some women

Findings from a prospective single-center study showed that bariatric surgery cured urinary incontinence in about 1 in 3 obese women.¹

“The findings of this study suggest that weight loss via bariatric surgery is an efficient method of managing SUI in obese women. A larger sample is needed to demonstrate the beneficial effect on urgency UI and mixed UI. For an obese female with urinary incontinence, treatment for obesity should prevail and incontinence should be treated only if symptoms remain after surgery,” the authors concluded.

At a minimum follow-up of 18 months after bariatric surgery, 31% (n = 16) of women in the study reported that they were completely cured of urinary incontinence. Additionally, scores on the ICIQ-UI SF urinary incontinence questionnaire significantly improved from a pre-surgery mean score of 13.31 ± 5.18 points to a mean score of 8.30 ± 4.49 points after surgery (P < .0001). The percentage of patients describing severe incontinence dropped from 70% before surgery to 37% after surgery.

The results also showed that, based on the VAS questionnaire, 85% of patients had improvement in their urinary incontinence after surgery. The mean number of pads used per day dropped from 7.04 ± 2.79 before surgery to 3.42 ± 2.77 (P < .001) post-surgery, with the percentage of patients using >1 pad daily decreasing from 65% to 17%.

Regarding type of incontinence, the cure rate was statistically significant among women with stress urinary incontinence (SUI). There was also a non–statistically significant improvement among patients with urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI). The authors wrote that the likely reason for this lack of statistical significance was that the study did not include enough patients with UUI or MUI.

Besides this likely lack of correlation between incontinence type and outcomes, the authors’ also did not find any correlation between post-surgery incontinence outcomes and patients’ BMI, age, or number/type of prior child deliveries.

“Patients who are candidates for bariatric surgery should be advised that improvement in UI may also be a significant benefit of their intervention. Our data show that bariatric surgery is able to cure urinary incontinence in one of three obese women,” the study authors wrote.

The study included 54 women with urinary incontinence who received bariatric surgery performed by bariatric surgeons at the authors’ clinic over a period of 9 years. To receive bariatric surgery, patients had to have a BMI ≥33 kg/m². The mean patient age was 37.1 years and the mean BMI before surgery was 42.5 kg/m².

Patientscould not have received prior surgery for urinary incontinence. Additionally, patients were not eligible to enroll in the study if they had pelvic organ prolapse, fistulas, or other malformations of the urinary tract.

Bariatric surgery was conducted with a laparoscopic approach, with patients receiving gastric sleeve, bypass, or banding, based on standard of care and physician–patient consultation. Patients completed the ICIQ—UI-SF urinary incontinence questionnaire prior to surgery and at follow-up visits. Patients also completed the 10-point VAS questionnaire at these visits to assess their perception of their incontinence symptoms after surgery. The study investigators assessed the data with t-test statistical analysis.

Limitations of the study acknowledged by the study authors included the short follow-up time and the relatively small study population size. Additional issues they noted were the study not being a randomized trial and the lack of control group.

“The findings of this study suggest that weight loss via bariatric surgery is an efficient method of managing SUI in obese women. A larger sample is needed to demonstrate the beneficial effect on urgency UI and mixed UI. For an obese female with urinary incontinence, treatment for obesity should prevail and incontinence should be treated only if symptoms remain after surgery,” the authors concluded.

Reference

1. Persu C, Cartas RN, Ciofu I, Mastalier B, Cauni VM. Is Surgical Treatment for Obesity Able to Cure Urinary Incontinence in Women?–A Prospective Single-Center Study. Life (Basel). 2023;13(9):1897. doi: 10.3390/life13091897