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Original Investigation |

Urinary Incontinence Before and After Bariatric Surgery

Leslee L. Subak, MD1,2,3,4; Wendy C. King, PhD5; Steven H. Belle, PhD, MScHyg5,6; Jia-Yuh Chen, MS6; Anita P. Courcoulas, MD, MPH7; Faith E. Ebel, RD, MS, MPH8; David R. Flum, MD, MPH9; Saurabh Khandelwal, MD9; John R. Pender, MD10; Sheila K. Pierson, BS7; Walter J. Pories, MD10; Kristine J. Steffen, PharmD, PhD11; Gladys W. Strain, PhD8; Bruce M. Wolfe, MD12; Alison J. Huang, MD, MAS13
[+] Author Affiliations
1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
2Department of Epidemiology and Biostatistics, University of California, San Francisco
3Department of Urology, University of California, San Francisco
4San Francisco Veterans Affairs Medical Center, San Francisco, California
5Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
6Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
7Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
8GI Metabolic and Bariatric Surgery, Weill Cornell Medical College, New York, New York
9Department of Surgery, University of Washington, Seattle
10Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
11Department of Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Grand Forks
12Department of Surgery, Oregon Health & Science University, Portland
13Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2015;175(8):1378-1387. doi:10.1001/jamainternmed.2015.2609.
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Importance  Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery–induced weight loss is lacking.

Objectives  To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery.

Design, Setting, and Participants  The Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012).

Intervention  Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter.

Main Outcomes and Measures  The frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up.

Results  Of 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m2 (range, 34-94 kg/m2), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P < .001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P < .001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P < .001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation.

Conclusions and Relevance  Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.

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Figure 1.
Study Participant Flow Diagram
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Figure 2.
Modeled Frequency of Urinary Incontinence Episodes and Prevalence of Any-Type, Stress-Type, and Urgency-Type Urinary Incontinence Before and After Bariatric Surgery

Each follow-up time point was compared with baseline. Bars indicate 95% CIs.

aThe overall P value for a time effect of change in prevalence of stress urinary incontinence among men was 0.31 so pairwise comparisons were not made.

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