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Pelvic Organ Prolapse and Urinary Incontinence in Women After Bariatric Surgery: 5-Year Follow-up

Gabriel, Iwona, MD, PhD*; Tavakkoli, Ali, MD; Minassian, Vatche, A., MD, MPH*

Female Pelvic Medicine & Reconstructive Surgery: March/April 2018 - Volume 24 - Issue 2 - p 120–125
doi: 10.1097/SPV.0000000000000505
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Objective The objective of this study was to determine if weight loss surgery is associated with decreased prevalence of urinary incontinence (UI) and pelvic organ prolapse (POP) symptoms.

Methods A survey was conducted among previously morbidly obese women who underwent bariatric surgery at Brigham and Women's Hospital, Boston from 2007 to 2015. In addition to the Pelvic Floor Distress Inventory 20, we collected demographic and clinical data including symptoms of and treatment for UI and POP before surgery. Participants were divided into 4 quartiles based on self-reported postsurgical weight loss: less than 26.1 kg, 26.1 to 36.2 kg, 36.3 to 46.2 kg, and greater than 46.2 kg. Cox proportional hazard ratios were used to estimate risk of UI and POP by quartile. Kruskal-Wallis test was used to compare bother scores between the groups.

Results A total of 447 women responded to the survey. Mean follow-up from surgery was 5 years. Women with Roux-en-Y gastric bypass had significantly greater weight loss than gastric banding or sleeve gastrectomy. The adjusted hazard ratios of current UI, stress UI, urgency UI, and prolapse decreased with increasing weight loss quartile (P trend <0.005). Based on the Pelvic Floor Distress Inventory 20, prevalence of POP symptoms was 26% with a mean bother score of 50. Although symptom bother by quartile of weight loss was not statistically significant, the trend (from the first to fourth quartile) for the mean values of Urogenital Distress Inventory 6 (from 13 to 9) and Pelvic Organ Prolapse Distress Inventory 6 (from 26 to 20) showed an improvement in bother symptoms.

Conclusions There exists an inverse relationship between amount of weight loss and subsequent POP and UI symptoms 5 years after bariatric surgery.

Significant weight loss after bariatric surgery results in improvement of prolapse and urinary incontinence symptoms in 5-year follow-up.

From the *Division of Urogynecology, and †Center for Weight Management and Metabolic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA.

Correspondence: Vatche A. Minassian, MD, MPH, Division of Urogynecology, Brigham and Women's Hospital, Harvard Medical School, 500 Brookline Ave, Suite 5E, Boston, MA 02215. E-mail: vminassian@bwh.harvard.edu.

The authors have declared they have no conflicts of interest.

Summary of this study has been accepted for oral poster presentation during American Urogynecologic Society Pelvic Floor Disorders Week 2017 (Ref 2733381) under the title Pelvic Organ Prolapse and Urinary Incontinence After Bariatric Surgery.

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