Bariatric Surgery Has a Long-Term Beneficial Impact on Urinary Incontinence in Women with Obesity

TL;DR

Bariatric surgery helps reduce urinary incontinence in obese women over the long term, with sleeve gastrectomy being more effective than gastric bypass.

Contribution

Demonstrates long-term UI improvement after bariatric surgery and identifies laparoscopic sleeve gastrectomy as more effective than OAGB.

Findings

Bariatric surgery significantly reduced urinary incontinence symptoms over five years.

Laparoscopic sleeve gastrectomy was more effective than one anastomosis gastric bypass in improving incontinence.

Vaginal childbirth was linked to a higher risk of persistent UI after surgery.

Abstract

Background and Objectives: To evaluate the long-term efficacy of bariatric surgery in ameliorating urinary incontinence in women with obesity. Additionally, to assess the impact of comorbidities on the persistence of symptoms and compare the effectiveness of two types of bariatric interventions. Materials and Methods: This prospective, single-centre study included 124 women with preoperative urinary incontinence (UI). A total of 92 (74.19%) responded to follow-up and underwent laparoscopic sleeve gastrectomy (LSG) (n = 52; 56.52%) or one anastomosis gastric bypass (OAGB) (n = 40; 43.48%). The cohort was divided into stress urinary incontinence (SUI) (n = 57; 61.96%), mixed urinary incontinence (MUI) (n = 33; 35.87%), and urge urinary incontinence (UUI) (n = 2; 2.17%). Before surgery, patients were assessed for comorbidities and completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) (score range 0–21) and the Urogenital Distress Inventory (UDI-6) (score range 0–100) questionnaires. After 5 years, the patients completed the same questionnaires again for the final assessment. Results: Bariatric surgery demonstrated a statistically significant reduction in UI symptoms (p < 0.001), with a more pronounced improvement in SUI than in MUI, and with complete resolution in patients experiencing UUI. LSG was more effective than OAGB at alleviating UI (p < 0.001 vs. p = 0.017). Notably, childbirth, particularly vaginal delivery, was associated with a higher risk of persistent UI after surgery (p = 0.025). The correlation between postoperative BMI and improvement in UI symptoms was not statistically significant (p = 0.64). Conclusions: Bariatric surgery provides a beneficial secondary effect on urinary incontinence (UI) in women with obesity who undergo the procedure for obesity. The LSG method is superior to OAGB when considering the improvement in incontinence symptoms. Furthermore, the LSG procedure should be considered the primary choice for women with obesity experiencing UI with a history of vaginal delivery.

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