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Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Lower Urinary Tract Symptoms in Males

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Abstract

Background

Obesity is a chronic disease with multisystem morbidity. There are multiple studies reporting the effect of bariatric surgery on cardiovascular and metabolic disease, but few examine its impact on lower urinary tract symptoms. This article aims to perform a systematic review with meta-analysis, to determine the effects of bariatric surgery on lower urinary tract symptoms in male patients.

Methods

Medline, Embase, conference proceedings, and reference lists were searched for studies reporting the quantitative measurement of lower urinary tract symptoms score pre- and postweight loss surgery. The primary outcome was International Prostate Symptom Score (IPSS) before and after bariatric surgery. Secondary outcomes were changed in body mass index (BMI) and total body weight (TBW). Weighted mean differences (MD) were calculated for continuous outcomes.

Results

Seven studies were included in the analysis of 334 patients undergoing bariatric surgery. Mean study follow-up was between 3 and 36 months. IPSS score ranged from 3–12.7 preoperatively and 1.9–6.9 postoperatively. There was a statistically significant improvement in the IPSS score following bariatric surgery (MD 2.82, 95% CI 0.96 to 4.69, p=0.003). Bariatric surgery also resulted in statistically significant reduction of BMI and TBW.

Conclusion

Bariatric surgery produces a significant improvement on lower urinary tract symptoms in men with obesity. This may be due to improvement of insulin sensitivity, testosterone levels or lipid profile associated with weight loss.

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References

  1. Bray GA, Frühbeck G, Ryan DH, et al. Management of obesity. Lancet. 2016;387(10031):1947–56.

    Article  Google Scholar 

  2. Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011;378(9793):815–25.

    Article  Google Scholar 

  3. Muller R, Gerber L, Moreira D, et al. 1736 Obesity is associated with increased prostate growth and attenuated prostate volume reduction by dutasteride. J Urol. 2012;187(4S):1115–21.

    Google Scholar 

  4. Lee RK, Chung D, Chughtai B, et al. Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms. BJU Int. 2012;110(4):540–5.

    Article  Google Scholar 

  5. Giovannucci E, Rimm EB, Chute CG, et al. Obesity and benign prostatic hyperplasia. Am J Epidemiol. 1994;140(11):989–1002.

    Article  CAS  Google Scholar 

  6. Vuichoud C, Loughlin KR. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22(October):1–6.

    PubMed  Google Scholar 

  7. Parsons JK, Sarma AV, McVary K, et al. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2013;189(1 SUPPL):S102–6.

    PubMed  Google Scholar 

  8. Khoo J, Piantadosi C, Worthley S, et al. Effects of a low-energy diet on sexual function and lower urinary tract symptoms in obese men. Int J Obes. 2010;34(9):1396–403.

    Article  CAS  Google Scholar 

  9. Purwar B, Cartwright R, Cavalcanti G, et al. The impact of bariatric surgery on liver disease: a systematic review and meta-analysis. Int Urogynaecology J. 2018;30(8):1225–37.

    Article  Google Scholar 

  10. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009 Aug 18;151(4):264–9.

    Article  Google Scholar 

  11. Barry MJ, Fowler FJ, O’Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association J Urol. 1992;148:1549–57.

    CAS  Google Scholar 

  12. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6.

    Article  Google Scholar 

  13. Barry MJ, Fowler FJ, O’leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol. 2017;197(2):S189–97.

    PubMed  Google Scholar 

  14. Ho Wong CK, EPH C, SWH C, et al. Use of the International Prostate Symptom Score (IPSS) in Chinese male patients with benign prostatic hyperplasia. Aging Male. 2017;20(4):241–9.

    Article  Google Scholar 

  15. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, (2020). editor(s). Cochrane handbook for systematic reviews of interventions version 6.1 (updated). Cochrane, 2020. Available from training.cochrane.org/handbook.

  16. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  Google Scholar 

  17. Grant J, Hunter A. Measuring inconsistency in knowledgebases. J Intell Inf Syst. 2006;27(2):159–84.

    Article  Google Scholar 

  18. Aleid M, Muneer A, Renshaw S, et al. Early effect of bariatric surgery on urogenital function in morbidly obese men. J Sex Med. 2017;14(2):205–14.

    Article  Google Scholar 

  19. Groutz A, Gordon D, Schachter P, et al. Mp87-11 Effects of bariatric surgery on male lower urinary tract symptoms and sexual function. J Urol. 2016;195(4S):e1118–9.

    Article  Google Scholar 

  20. Fujisaki A, Mizumura Y, Haruyama I, et al. Time-dependent changes in lower urinary tract symptoms in Japanese patients who undergo bariatric and metabolic surgery. Int J Urol. 2019;26(4):524–6.

    Article  Google Scholar 

  21. Luke S, Addison B, Broughton K, et al. Effects of bariatric surgery on untreated lower urinary tract symptoms: a prospective multicentre cohort study. BJU Int. 2015;115(3):466–72.

    Article  CAS  Google Scholar 

  22. Uruç F, Akan S, Aras B, et al. Effects of obesity surgery (laparoscopic sleeve gastrectomy technique) on lower urinary tract symptoms, depression and quality of life of males: prospective study. Arch Ital di Urol Androl organo Uff [di] Soc Ital di Ecogr Urol e Nefrol. 2016;88(4):258–61.

    Google Scholar 

  23. Ranasinghe WKB, Wright T, Attia J, et al. Effects of bariatric surgery on urinary and sexual function. BJU Int. 2011;107(1):88–94.

    Article  Google Scholar 

  24. Liu SYW, Yee CH, Chiu PKF, Lam CCH, Wong SKH, Ng EKW, et al, (2020). The effect of bariatric surgery on the improvement of lower urinary tract symptoms in morbidly obese male patients. Prostate Cancer Prostatic Dis.

  25. Barry MJ, Williford WO, Chang Y, et al. Benign prostatic hyperplasia specific health status measures in clinical research: how much change in the American Urological Association symptom index and the benign prostatic hyperplasia impact index is perceptible to patients? J Urol. 1995;154(5):1770–4.

    Article  CAS  Google Scholar 

  26. Hammarsten J, Högstedt B. Clinical, anthropometric, metabolic and insulin profile of men with fast annual growth rates of benign prostatic hyperplasia. Blood Press. 1999;8(1):29–36.

    Article  CAS  Google Scholar 

  27. Rohrmann S, De Marzo AM, Smit E, et al. Serum C-reactive protein concentration and lower urinary tract symptoms in older men in the third National Health and Nutrition Examination Survey (NHANES III). Prostate. 2005;62(1):27–33.

    Article  CAS  Google Scholar 

  28. Zucchetto A, Tavani A, Dal Maso L, et al. History of weight and obesity through life and risk of benign prostatic hyperplasia. Int J Obes. 2005;29(7):798–803.

    Article  CAS  Google Scholar 

  29. Breyer BN, Creasman JM, Richter HE, et al. A behavioral weight loss program and nonurinary incontinence lower urinary tract symptoms in overweight and obese women with urinary incontinence: a secondary data analysis of PRIDE. J Urol. 2018;199(1):215–22.

    Article  Google Scholar 

  30. Kozlowski R, Kershen RT, Siroky MB, et al. Chronic ischemia alters prostate structure and reactivity in rabbits. J Urol. 2001;165(3):1019–26.

    Article  CAS  Google Scholar 

  31. Ponholzer A, Temml C, Obermayr RP, et al. The association between lower urinary tract symptoms and renal function in men: a cross-sectional and 5-year longitudinal analysis. J Urol. 2006;175(4):1398–402.

    Article  Google Scholar 

  32. Lupoli R, Di Minno MND, Guidone C, et al. Effects of bariatric surgery on markers of subclinical atherosclerosis and endothelial function: a meta-analysis of literature studies. Int J Obes. 2016;40(3):395–402.

    Article  CAS  Google Scholar 

  33. Głuszek S, Bociek A, Suliga E, et al. The effect of bariatric surgery on weight loss and metabolic changes in adults with obesity. Int J Environ Res Public Health. 2020;17(15):1–11.

    Article  Google Scholar 

  34. Johnson TV, Schoenberg ED, Abbasi A, et al. Assessment of the performance of the American Urological Association symptom score in 2 distinct patient populations. J Urol. 2009;181:230–7.

    Article  Google Scholar 

  35. Miras AD, Kamocka A, Patel D, et al. Obesity surgery makes patients healthier and more functional: real world results from the United Kingdom National Bariatric Surgery Registry. Surg Obes Relat Dis. 2018;14(7):1033–40.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of General Surgery, East Surrey Hospital, Redhill, UK

    Irena Stefanova

  2. Department of Bariatric Surgery, Ashford and St Peters Hospital Trust, Guildford Street, Chertsey, KT16 0PZ, UK

    Andrew C. Currie

  3. Department of Bariatric Surgery, St Richard’s Hospital, Chichester, UK

    Richard C. Newton, Guy Slater, William Hawkins & Christopher Pring

  4. Department of Bariatric Surgery and Diabetes, St Richard’s Hospital, Chichester, UK

    Lorraine Albon

  5. Department of Urology, St Richard’s Hospital, Chichester, UK

    Angela Birnie

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  1. Irena Stefanova
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  4. Lorraine Albon
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  5. Guy Slater
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  6. Angela Birnie
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  7. William Hawkins
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Contributions

IS, ACC, WH, and CP were involved in research design. IS, ACC, and RCN were involved in data acquisition. All authors were involved in data interpretation, production of the manuscript, and critical revisions. All authors approved the final submitted manuscript.

Corresponding author

Correspondence to Andrew C. Currie.

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This study was a systematic review of published research; therefore, no ethical or governance approvals were required.

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The authors declare no competing interests.

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Irena Stefanova and Andrew C. Currie Joint first authors

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Stefanova, I., Currie, A.C., Newton, R.C. et al. Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Lower Urinary Tract Symptoms in Males. OBES SURG 31, 3151–3158 (2021). https://doi.org/10.1007/s11695-021-05403-z

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  • DOI: https://doi.org/10.1007/s11695-021-05403-z

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