Is bariatric surgery the answer to urinary incontinence in obese women?

Aims: To investigate the effect of bariatric surgery on female pelvic floor disorders. Methods: Eighty consecutive obese women who underwent a laparoscopic sleeve gastrectomy were prospectively enrolled. Four validated questionnaires (ICIQ-UI, BFLUTS-SF, PFDI-20, PISQ-12) were used to evaluate pelvic floor symptoms before and 6 months after surgery. Outcome results were analyzed according to the presence of preoperative urinary incontinence (UI), defined as a positive answer to the question “how often do you leak urine?” on the ICIQ-UI questionnaire. Results: Seventy-seven women (age 41.3 ± 11.5 years; parity 1.9 ± 1.6) completed all pre- and postoperative questionnaires. Mean body mass index (BMI) before and 6 months after surgery was 42 ± 4.7 and 33 ± 4.7, respectively. Preoperatively, 29 (37.7%) women (mean age 45.6 ± 11, mean BMI 42.3 ± 5.2) had UI, 17 (59%) of whom had stress urinary incontinence. Surgically induced weight loss was associated with statistically significant improvement in UI and filling symptoms, pelvic organ prolapse and colorectal-anal scores, and condition-specific sexual function and quality of life parameters. Specifically, the total score of the ICIQ-UI questionnaire decreased from 9.28 ± 3.6 preoperatively to 2.9 ± 3.8 postoperatively (P < 0.001), and the urinary score of the PFDI-20 questionnaire decreased from 31.4 ± 17.9 preoperatively to 9.3 ± 12.3 postoperatively (P < 0.001). Furthermore, 15 (51.7%) women reported complete resolution of UI following weight loss. Conclusion: Surgically induced weight loss resulted in resolution of UI in up to 52% of preoperatively incontinent women and subsequent improvement in other pelvic floor symptoms. Larger studies with longer follow-up are required to investigate the possible impacts of bariatric surgery on various aspects of pelvic floor function. Neurourol. Urodynam. 36:184–187, 2017.