PD06-06 EFFECT OF BARIATRIC SURGERY ON URINARY INCONTINENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
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 ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.036 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.013 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.067 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".