Prospective Study of the Effect of Laparoscopic Sleeve Gastrectomy for Morbid Obesity on Overactive Bladder Symptoms
Morbidly obese patients may experience lower urinary tract symptoms. However, most studies focus only on urinary incontinence, with little regard to other symptoms as those suggestive for overactive bladder syndrome, which is characterized by the presence of urgency with or without urinary urgency incontinence (UUI), usually with frequency and nocturia . Laparoscopic sleeve gastrectomy (LSG) is now a common surgical procedure for obesity, and within the last decade, several authors have proposed that it is the definitive treatment for morbid obesity based on its efficacy and safety in large randomized trials. This procedure is capable of reducing the impact of comorbidities associated with severe increase in body weight. Therefore, we investigated if LSG improves overactive bladder symptoms in morbidly obese patients.
Methods and results
We prospectively recruited 120 morbidly obese patients (60 men, 60 women), evaluated by history taking, comorbidity assessment, physical examination, urinalysis and urine culture, renal and pelvic ultrasound, a 3-day voiding diary, and the overactive bladder questionnaire short form. Outcomes of these investigations were assessed 7 days before and 180 days after LSG was performed. Controls were obese individuals (60 men and 60 women) from an LSG waiting list.
Symptoms of overactive bladder were common in the morbidly obese cohort, affecting more women than men. Compared with untreated patients, patients treated with LSG had significantly reduced body mass index 180 days postoperatively; this outcome was associated with improvement in overactive bladder symptoms, whereas no change occurred in untreated controls.
Obese patients present several comorbidities and most of these may differently contribute to develop LUTS, including OAB symptoms. Some authors report that a reduced space in the pelvis may determine a compression of the bladder thus to reduce cystometric capacity and consequently inducing urinary frequency and urinary urgency. Other authors hypothesize a neurogenic origin of urinary urgency in obese individuals suffering from diabetes (which is considered a sub-population). Weight reduction surely contributes to improve cardiovascular and respiratory condition of obese subjects; furthermore, a significant rate of obese patients with diabetes does not require anti-diabetic therapy after bariatric surgery. Preliminary data coming from our pilot study show that also urinary symptoms may benefit from BMI reduction provided by bariatric surgery. This investigation shows that OAB is well represented in obese subjects and that symptoms significantly improve after bariatric surgery.
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