INFLUENCE OF BARIATRIC AND METABOLICSURGERY ON URINARY INCONTINENCE AMONG JAPANESE FEMALE PATIENTS
A. FUJISAKI1, M.SHIMOINABA 1, S. HONDA 1, Y. SEKI 2,K. KASAMA 2, Y. YOSHIMURA 1;
1Departmentof Urology, Yotsuya Med. Cube, Tokyo, Japan, 2Weight Lossand Metabolic Surgery Center, Yotsuya Med. Cube, Tokyo, Japan.
Introduction: Japan is one ofthe countries that have the lowest obesity rate in the world.However, the number of patients who undergo bariatric and metabolicsurgery (BMS) for the treatment of obesity and diabetes is increasingin Japan as well. The levels of BMI of the Japanese subjects are lowcompared with those in the Western countries because metabolicsurgery, which is primarily intended to cure type 2 diabetes, isperformed for most of the cases in Japan. Although some previousstudies conducted in Western countries involving subjects with highlevels of BMI described the improvement of incontinence after BMS,few reports have been published in Japan where the levels of BMI ofthe subjects are relatively low.
Objective: The objectiveof this study was to clarify the effect of BMS on incontinence amongthe Japanese female patients.
Methods: A retrospectivechart review was performed for 55 Japanese women who underwent BMS atour clinic. Patients were evaluated for their urination using padusage and three kinds of questionnaires such as InternationalConsultation on Incontinence Questionnaire-Short Form (ICIQ-SF),Overactive Bladder Syndrome Score (OABSS), and International ProstateSymptom Score (IPSS) at baseline, 1, 3, 6, 12, and 18 monthsfollowing surgery. Differences were considered statisticallysignificant at a p value <0.05. All statistical analyses wereperformed using IBM SPSS version 21 (SPSS Inc., Chicago, Ill., USA).This study was approved by the institutional review boards of YotsuyaMedical Cube.
Results: The median age of the subjects was44(23-64) years. The following numbers (percentages) of cormobiditieswere observed respectively in patients at baseline: diabetes, 26cases (47.3%); hypertension, 23 cases (41.8%); sleep apnea syndrome,39 cases (70.9%); and smoker, 16 cases (29.1%). The median time ofsurgery was 146(56-263) minutes. Surgical procedures included 8 casesof Roux-en-Y Gastric bypass (14.5%), 13 cases of sleeve gastrectomywith duodenojejunal bypass (23.6%), 30 cases of sleeve gastrectomy(54.5%), and 4 cases of gastric banding (7.3%). The medianpreoperative BMI was 36.9(28.8-50.6) kg/m2. The postoperative BMIbegan to decrease significantly from month 1, which continuedthroughout the whole follow-up period and reached 28.7(21.9-39.6)kg/m2 at 12 months following surgery (P<0.01). The medianpreoperative HbA1c was 6.0(4.3-10.4) %. The postoperative HbA1c beganto decrease significantly from month 3 and reached 5.6(4.8-11.3) % at12 months following surgery (P<0.01). In addition, dosage ofdiabetic medicine was reduced substantially following surgery. Allthe subjects had not received urological treatment interventions inany period. Compared between baseline and month 12, prevalence ofurinary incontinence decreased from 67.3% to 28.9% (P<0.01),stress urinary incontinence decreased from 63.6% to 24.4%, urgeurinary incontinence decreased from 20.0% to 9.1%, and the pad usagerate decreased from 41.8% to 13.6% (P<0.01). Whereas, scores ofeach questionnaire changed as follows. ICIQ-SF: from 4(0-19) pointsto 0(0-10) point (P<0.01); OABSS: from 2(0-10) points to 0.5(0-7)points (P<0.01); IPSS total score: from 3(0-32) points to 1 (0-30)point (P<0.01); IPSS urinary symptoms domain: from 2 (0-20) pointsto 1 (0-20) point (P=0.08); and IPSS storage symptoms domain: from1(0-12) point to 1(0-10) point (P<0.01). The improvement tendencywas more evident in storage symptoms than in urinarysymptoms.
Conclusions: Similarly, as described in theprevious studies in the Western countries, the Japanese patients werealso observed with improvement in incontinence by BMS alone withouturological treatment intervention. On the other hand, compared to thedata from Western countries, smaller change of BMI after BMSdemonstrated the significant improvement of urinary incontinence.Thus, it is assumed that not only BMI but also other factors might beinvolved in the improvement of lower urinary tractsymptoms.
References: 1. OECD Obesity Update. 2014.2. JAMAIntern Med. 2015; 175: 1378-87. 3. Neurourol Urodyn. 2015; 36:184-187.