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The impact of bariatric surgery on urinary incontinence: a systematic review and meta-analysis

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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.

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Authors and Affiliations

  1. Department of Urogynaecology, Singleton Hospital, Sketty Lane, Swansea, Wales, SA2 8QA, UK

    Bhawana Purwar

  2. Department of Urogynaecology, John Radcliffe Hospital, Oxford, UK

    Rufus Cartwright

  3. Federal University of Pernambuco (UFPE), Recife, Brazil and University of Pernambuco (UPE), campus Recife, Recife, Brazil

    Geraldo Cavalcanti

  4. Department of Urogynaecology, St Mary’s Hospital, London, UK

    Giuseppe Alessandro Digesu, Ruwan Fernando & Vik Khullar

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  1. Bhawana Purwar
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Correspondence to Bhawana Purwar.

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Purwar, B., Cartwright, R., Cavalcanti, G. et al. The impact of bariatric surgery on urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 30, 1225–1237 (2019). https://doi.org/10.1007/s00192-018-03865-x

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