PD06-06 EFFECT OF BARIATRIC SURGERY ON URINARY INCONTINENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS
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Résumé
You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (PD06)1 Apr 2019PD06-06 EFFECT OF BARIATRIC SURGERY ON URINARY INCONTINENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS Yung Lee, James Yu, Michał Pędziwiatr, Piotr Major, Ishan Aditya*, Kari Tikkinen, Yonah Krakowsky, Aristithes Doumouras, Scott Gmora, Mehran Anvari, and Dennis Hong Yung LeeYung Lee More articles by this author , James YuJames Yu More articles by this author , Michał PędziwiatrMichał Pędziwiatr More articles by this author , Piotr MajorPiotr Major More articles by this author , Ishan Aditya*Ishan Aditya* More articles by this author , Kari TikkinenKari Tikkinen More articles by this author , Yonah KrakowskyYonah Krakowsky More articles by this author , Aristithes DoumourasAristithes Doumouras More articles by this author , Scott GmoraScott Gmora More articles by this author , Mehran AnvariMehran Anvari More articles by this author , and Dennis HongDennis Hong More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555190.18045.d0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Obesity is a major risk factor for urinary incontinence (UI). For treating UI in obese patients, current guidelines recommend weight loss through lifestyle interventions. However, the role of sustained weight loss induced by bariatric surgery for the treatment of UI in obese patients remains unclear. We aimed to conduct a systematic review and meta-analysis to critically evaluate the effect of bariatric surgery on UI in obese patients. METHODS: We searched Medline, EMBASE, CENTRAL, PubMed, and relevant major conference abstracts up to June 2018, including any studies that compared UI status in obese patients before and after bariatric surgery. Primary outcomes were improvement or complete resolution of stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) before and after surgery. Secondary outcomes were validated urinary incontinence questionnaires: urogenital distress inventory (UDI-6), International Consultation on Incontinence Questionnaire (ICIQ), and Incontinence Impact Questionnaire (IIQ) before and after surgery. Pooled estimates were calculated using random-effects or proportions meta-analysis and heterogeneity was quantified using the I2 statistic. Two reviewers independently reviewed the studies, collected data, assessed risk of bias, and conducted Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) to assess quality of evidence. RESULTS: 35 cohort studies involving a total of 9,250 obese patients (90.8% female) met the inclusion criteria with a median follow up of 15 months after surgery (range, 6 to 60 months). The weighted mean BMI at baseline was 45.7+/-6.9 kg/m2 and 32.2+/-5.9 kg/m2 at follow-up, with an relative reduction of 29.7% after bariatric surgery. Bariatric surgery resulted in improvement or resolution of any UI in 58% (95% CI, 50-65%), SUI in 47% (95% CI, 34-60%), and UUI in 37% of patients (95%CI, 15-62%). Moreover, bariatric surgery significantly decreased UDI-6 scores by 14.7 points (95% CI, 9.6-19.7, P<0.001), ICIQ score by 4.5 points (95% CI, 2.9-6.0, P<0.001), and IIQ scores by 5.3 (95% CI, 3.9-6.6, P<0.001) after surgery. Conversely, 3% (95% CI, 0-13%) of patients experienced worsening or new onset of UI after bariatric surgery. All meta-analysed outcomes had high heterogeneity (I2>50%). CONCLUSIONS: Bariatric surgery leads to improvement or resolution of SUI in half and of UUI in more than one-third of obese patients. Large scale comparative studies are warranted to further examine the benefits and harms of bariatric surgery as treatment for UI. Source of Funding: none. Hamilton, Canada; Krakow, Poland; Toronto, Canada; Helsinki, Finland; Toronto, Canada; Hamilton, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e138-e138 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yung Lee More articles by this author James Yu More articles by this author Michał Pędziwiatr More articles by this author Piotr Major More articles by this author Ishan Aditya* More articles by this author Kari Tikkinen More articles by this author Yonah Krakowsky More articles by this author Aristithes Doumouras More articles by this author Scott Gmora More articles by this author Mehran Anvari More articles by this author Dennis Hong More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,036 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,006 | 0,013 |
| Bibliométrie | 0,004 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,067 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».