Hypothesis / aims of study
Obesity is a known risk factor for urinary incontinence, described as being associated with twice the risk for stress UI and three times the risk for urge UI. Obese women have greater abdominal mass and consequently increased intra-abdominal and intravesical pressure, as well as pelvic floor changes that lead to dysregulation of the mechanism responsible for urinary continence.
The aim of the study is to determine the impact of bariatric surgery on the severity of urinary incontinence in obese women and to assess the impact of other known risk factors, comparing women in the preoperative period (stage 0) with women at 6 to 12 months (stage 1) and 12 to 18 months (stage 2) postoperatively
Study design, materials and methods
Women followed up in a multidisciplinary consultation for bariatric surgery answered anonymously the ICIQ-SF (International Consultation on Incontinence Questionnaire–Short Form), translated and validated for the Portuguese population. The patient was previously weighed and the body mass index (BMI) and percentage of weight loss were calculated.
To characterize the sample, data were collected from the clinical process of the patients about pelvic surgical history, obstetric index and type of delivery, menopause, presence of diabetes, corroborated with glycated hemoglobin (HbA1c).
Statistical analysis was performed using SPSS version 20.0. All p values were considered statistically significant for p≤0.05. The Kruskal-Walis and McNemar's chi-square tests were used for continuous and categorical variables, respectively.
Results
Of the 50 women who completed the ICIQ-SF, 8 were excluded due to surgical complications or need for reintervention, 17 were in the preoperative period and 25 were in the follow-up period.
The mean age of the study population was 46 years (24-67 years). The median number of pregnancies was 2, and the percentage of nulliparous women was 14.3%; 33.3% of the women had a vaginal delivery, 33.3% cesarean section and 19% vaginal delivery and cesarean section.
Regarding pathological history, 19% of patients were diabetic, 38.1% had undergone previous pelvic surgery and 21.4% were menopausal.
In the preoperative anthropometric assessment, the mean weight was 109.25 kg, with a BMI ranging between 35.7 and 46.9 kg/m2.
The average weight losses in stages 1 and 2 were 28.11% and 35.03%, respectively.
In the preoperative period, 58.8% had UI: 17.6% mild, 17.6% moderate and 23.5% severe. In stage 1, 36.4% had UI: 9.1% mild, 18.2% moderate and 9.1% severe. In stage 2, 21.4% have UI: 7.1% mild and 14.3% moderate. In global terms, the classification of the type of UI was: urgency (41.2%), effort (41.2%) and mixed (5.9%).
Interpretation of results
After statistical analysis of the results obtained in the group of patients in the preoperative stage, it was found that weight (p=0.015) and BMI (p=0.007) were associated with more severe forms of UI (moderate and severe). It was also found that the ICIQ classification in this group was significantly higher (p=0.034) than the classification of the postoperative group.