THE EFFECT OF BARIATRIC SURGERY ONURINARY INCONTINENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS
B. PURWAR1, R.CARTWRIGHT 2, G. CAVALCANTI 3, A. DIGESU 1,R. FERNANDO 4, V. KHULLAR 2;
1ImperialColl. Hosp. NHS Trust, London, United Kingdom, 2ImperialColl. London, London, United Kingdom, 3Federal Univ. ofPernambuco, Brazil, Brazil, 4Imperial Coll. Hlth.care NHSTrust, London, United Kingdom.
Introduction: Obesity is agrowing worldwide pandemic with a huge burden of associated healthconsequences. Overweight and obese patients are at risk of all lowerurinary tract symptoms including stress and urgency urinaryincontinence (UI). Improvements in urinary incontinence have beenreported after weight loss, with the most significant effect onstress urinary incontinence (1, 2).
Objective: We aimed tosystematically review and meta-analyse all available studiesreporting the effect of surgically induced weight loss on urinaryincontinence.
Methods: We searched for studies reportingoutcome of urinary incontinence before and after surgically inducedweight loss surgery. We searched Medline, Embase, and the Cochranelibrary up to September 2016. The references of eligible studies werealso hand searched. Our search was restricted to studies published inEnglish. Studies were screened following pre-specified inclusioncriteria. The Newcastle-Ottawa quality assessment scale for cohortstudies was used to assess the quality of studies by two independentreviewers. Disagreement was resolved by consensus. We screened 105abstracts and retrieved 35 full text articles. 23 publications wereincluded for systematic review and 16 publications (1,052 patients)were included for meta-analysis. Different urinary symptomquestionnaires employed in different studies were standardised on ascale of 0-100 to enable pooling. We calculated standardised meandifference (SMD) of urinary symptom scores ±95% Confidence intervals(CI) before and after bariatric surgery. Data were analysed usingmetan, metafunnel and metareg for Stata 14 using random effects (D+L)models.
Results: There were no randomised controlled trials(RCTS) identified. Post-operatively urinary scores of patients wereimproved in all studies (SMD= -0.838;CI= -1.035 to -0.641, p<0.0001),but with substantial heterogeneity (I2 =78.2%). Results wereunchanged in sensitivity analyses excluding each study once. Weexplored the heterogeneity using metaregression, testing the type ofbariatric surgery and change in BMI as predictors of effect size,neither of which were significant predictors. Differences betweenstudies may therefore relate to different sampling approaches andchoice and timing of outcome assessments. A funnel plot showed noevidence of publication bias.
Conclusions: Evidence fromcohort studies suggests that there is a clinically highly meaningfulimprovement in urinary symptom scores of women after bariatricsurgery, but with substantial differences between studies. Furtherstudies are needed to explore how bariatric surgery impacts onindividual subtypes of incontinence, and to investigate which typesof surgery offer the largest benefit for LUTS.
References:1. Obes Rev;15(7):610-7. 2. JAMA Intern Med;175(8):1378-87.