Bhawana Purwar1, Rufus Cartwright2, Geraldo Cavalcanti3, Giuseppe Alessandro Digesu4, Ruwan Fernando4, Vik Khullar4. 1. Department of Urogynaecology, Singleton Hospital, Sketty Lane, Swansea, Wales, SA2 8QA, UK. drbhawanapurwar@yahoo.com. 2. Department of Urogynaecology, John Radcliffe Hospital, Oxford, UK. 3. Federal University of Pernambuco (UFPE), Recife, Brazil and University of Pernambuco (UPE), campus Recife, Recife, Brazil. 4. Department of Urogynaecology, St Mary's Hospital, London, UK.
Abstract
INTRODUCTION AND HYPOTHESIS: Obesity and overweight are strongly associated with stress and urgency urinary incontinence, and weight loss has been associated with improvement in urinary incontinence. We aimed to measure pooled effect sizes for different weight loss procedures on incontinence-specific quality of life and incontinence cure rate in a systematic review and meta-analysis. METHODS: MEDLINE, Embase and the Cochrane library were searched using a pre-defined strategy for relevant cohort studies. Random effects meta-analyses were conducted for the weighted mean difference for urinary quality of life scores and weighted overall pooled estimates for proportions of women cured. We explored heterogeneity using meta-regression, testing the type of bariatric surgery and change in BMI as predictors of effect size. The studies were categorised as either low or high risk of bias using a novel instrument specifically designed for longitudinal symptom research studies. RESULTS: Twenty-three studies (n = 3,225) were included. Incontinence-specific quality of life scores were improved by 14% (weighted mean difference = -14.79; CI = -18.47 to -11.11; I2 = 87.1%); the proportion of women cured of any urinary incontinence was 59% (95% CI = 51 to 66%) and the proportion of women cured of stress urinary incontinence was 55% (95% CI = 40 to 70%). CONCLUSIONS: Bariatric surgery results in clinically meaningful improvements in incontinence-specific quality of life. Current data are limited by both short-term follow-up and unexplained heterogeneity among studies.
INTRODUCTION AND HYPOTHESIS: Obesity and overweight are strongly associated with stress and urgency urinary incontinence, and weight loss has been associated with improvement in urinary incontinence. We aimed to measure pooled effect sizes for different weight loss procedures on incontinence-specific quality of life and incontinence cure rate in a systematic review and meta-analysis. METHODS: MEDLINE, Embase and the Cochrane library were searched using a pre-defined strategy for relevant cohort studies. Random effects meta-analyses were conducted for the weighted mean difference for urinary quality of life scores and weighted overall pooled estimates for proportions of women cured. We explored heterogeneity using meta-regression, testing the type of bariatric surgery and change in BMI as predictors of effect size. The studies were categorised as either low or high risk of bias using a novel instrument specifically designed for longitudinal symptom research studies. RESULTS: Twenty-three studies (n = 3,225) were included. Incontinence-specific quality of life scores were improved by 14% (weighted mean difference = -14.79; CI = -18.47 to -11.11; I2 = 87.1%); the proportion of women cured of any urinary incontinence was 59% (95% CI = 51 to 66%) and the proportion of women cured of stress urinary incontinence was 55% (95% CI = 40 to 70%). CONCLUSIONS: Bariatric surgery results in clinically meaningful improvements in incontinence-specific quality of life. Current data are limited by both short-term follow-up and unexplained heterogeneity among studies.
Authors: Cedric K Olivera; Daniel M Herron; Subhash U Kini; Michael D Vardy; Charles J Ascher-Walsh; Alan D Garely; Shimon Ginath; Michael L Brodman Journal: Am J Obstet Gynecol Date: 2012-06-23 Impact factor: 8.661
Authors: Leslee L Subak; Rena Wing; Delia Smith West; Frank Franklin; Eric Vittinghoff; Jennifer M Creasman; Holly E Richter; Deborah Myers; Kathryn L Burgio; Amy A Gorin; Judith Macer; John W Kusek; Deborah Grady Journal: N Engl J Med Date: 2009-01-29 Impact factor: 91.245
Authors: Rajesh Kuruba; Taghreed Almahmeed; Ferdinand Martinez; Tracy A Torrella; Krista Haines; Lana G Nelson; Scott F Gallagher; Michel M Murr Journal: Surg Obes Relat Dis Date: 2007-10-18 Impact factor: 4.734