The Impact of Bariatric Surgery on Pelvic Floor Dysfunction: A Systematic Review
To determine the effect of bariatric surgery (BS) on the prevalence of pelvic floor dysfunctions (PFD), specifically on urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI). A systematic review (PROSPERO registration no. CRD42017068452) with a literature search was per...
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| Veröffentlicht in: | Journal of minimally invasive gynecology 2019-07, Vol.26 (5), p.816-825 |
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| creator | Montenegro, Marcelo Slongo, Helena Juliato, Cassia Raquel Teatin Minassian, Vatche Arakel Tavakkoli, Ali Brito, Luiz Gustavo Oliveira |
| description | To determine the effect of bariatric surgery (BS) on the prevalence of pelvic floor dysfunctions (PFD), specifically on urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI).
A systematic review (PROSPERO registration no. CRD42017068452) with a literature search was performed using the PubMed, Scopus, and SciELO databases for all publications related to BS and PFD, with no language restrictions, from inception to September 2018.
Two authors screened for study eligibility and extracted data. Only prospective cohorts assessing women with morbid obesity and the prevalence of PFD before and after BS in multiple academic and private centers were included. UI, POP, and FI were defined according to the International Urogynecological Association/International Continence Society joint consensus, and diagnosis was made based on self-report or questionnaires.
Our search strategy retrieved 957 results. Of those, 28 studies were included for full analysis, and 20 studies (n = 3684 patients) were selected for final analysis. The main reasons for exclusion were missing data before and after BS (n = 7) and combined data of men and women who underwent BS (n = 1). Laparoscopic Roux-en-Y gastric bypass was the most common surgical technique. Pooled analysis (16 studies) showed that women had a mean body mass index reduction of 12.90 kg/m2 after treatment (95% confidence interval [CI], -14.82 to -10.97; p < .0001). The relative risk reduction was 67% (n = 19; odds ratio [OR], 0.33; 95% CI, 0.26–0.41; p < .0001) for UI, 52% (n = 5; OR, 0.48; 95% CI, 0.22–1.07; p = .07) for POP, and 20% (n = 9; OR, 0.80; 95% CI, 0.53–1.21; p = .29) for FI. Funnel plots for UI and FI did not suggest any publication bias. With regard to the standardized questionnaires for PFD, the International Consultation on Incontinence–Short Form, Pelvic Floor Impact Questionnaire-7 and its subscale Colorectal-Anal Impact Questionnaire-7, Pelvic Floor Distress Inventory-20, and its subscale Urinary Distress Inventory-6 showed statistically significantly lower scores. Sexual function, represented by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, showed no statistically significant improvement after surgery.
BS has a significant impact on reducing UI, but FI and POP, in obese women. |
| doi_str_mv | 10.1016/j.jmig.2019.01.013 |
| format | Article |
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A systematic review (PROSPERO registration no. CRD42017068452) with a literature search was performed using the PubMed, Scopus, and SciELO databases for all publications related to BS and PFD, with no language restrictions, from inception to September 2018.
Two authors screened for study eligibility and extracted data. Only prospective cohorts assessing women with morbid obesity and the prevalence of PFD before and after BS in multiple academic and private centers were included. UI, POP, and FI were defined according to the International Urogynecological Association/International Continence Society joint consensus, and diagnosis was made based on self-report or questionnaires.
Our search strategy retrieved 957 results. Of those, 28 studies were included for full analysis, and 20 studies (n = 3684 patients) were selected for final analysis. The main reasons for exclusion were missing data before and after BS (n = 7) and combined data of men and women who underwent BS (n = 1). Laparoscopic Roux-en-Y gastric bypass was the most common surgical technique. Pooled analysis (16 studies) showed that women had a mean body mass index reduction of 12.90 kg/m2 after treatment (95% confidence interval [CI], -14.82 to -10.97; p < .0001). The relative risk reduction was 67% (n = 19; odds ratio [OR], 0.33; 95% CI, 0.26–0.41; p < .0001) for UI, 52% (n = 5; OR, 0.48; 95% CI, 0.22–1.07; p = .07) for POP, and 20% (n = 9; OR, 0.80; 95% CI, 0.53–1.21; p = .29) for FI. Funnel plots for UI and FI did not suggest any publication bias. With regard to the standardized questionnaires for PFD, the International Consultation on Incontinence–Short Form, Pelvic Floor Impact Questionnaire-7 and its subscale Colorectal-Anal Impact Questionnaire-7, Pelvic Floor Distress Inventory-20, and its subscale Urinary Distress Inventory-6 showed statistically significantly lower scores. Sexual function, represented by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, showed no statistically significant improvement after surgery.
BS has a significant impact on reducing UI, but FI and POP, in obese women.</description><identifier>ISSN: 1553-4650</identifier><identifier>EISSN: 1553-4669</identifier><identifier>DOI: 10.1016/j.jmig.2019.01.013</identifier><identifier>PMID: 30708118</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bariatric surgery ; Bariatric Surgery - methods ; Body Mass Index ; Fecal incontinence ; Fecal Incontinence - epidemiology ; Female ; Humans ; Obesity, Morbid - complications ; Obesity, Morbid - surgery ; Pelvic Floor - surgery ; Pelvic Floor Disorders - epidemiology ; Pelvic Floor Disorders - surgery ; Pelvic organ prolapse ; Pelvic Organ Prolapse - complications ; Pelvic Organ Prolapse - physiopathology ; Pelvic Organ Prolapse - surgery ; Prevalence ; Prospective Studies ; Risk Factors ; Sexual Behavior ; Surveys and Questionnaires ; Systematic review ; Urinary incontinence ; Urinary Incontinence - surgery ; Weight Loss</subject><ispartof>Journal of minimally invasive gynecology, 2019-07, Vol.26 (5), p.816-825</ispartof><rights>2019 AAGL</rights><rights>Copyright © 2019 AAGL. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-253968e526a5822022a999185ca79207100db495a939ecc3a89616a7f3c29bab3</citedby><cites>FETCH-LOGICAL-c400t-253968e526a5822022a999185ca79207100db495a939ecc3a89616a7f3c29bab3</cites><orcidid>0000-0002-7364-4718 ; 0000-0003-3197-1195</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jmig.2019.01.013$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30708118$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Montenegro, Marcelo</creatorcontrib><creatorcontrib>Slongo, Helena</creatorcontrib><creatorcontrib>Juliato, Cassia Raquel Teatin</creatorcontrib><creatorcontrib>Minassian, Vatche Arakel</creatorcontrib><creatorcontrib>Tavakkoli, Ali</creatorcontrib><creatorcontrib>Brito, Luiz Gustavo Oliveira</creatorcontrib><title>The Impact of Bariatric Surgery on Pelvic Floor Dysfunction: A Systematic Review</title><title>Journal of minimally invasive gynecology</title><addtitle>J Minim Invasive Gynecol</addtitle><description>To determine the effect of bariatric surgery (BS) on the prevalence of pelvic floor dysfunctions (PFD), specifically on urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI).
A systematic review (PROSPERO registration no. CRD42017068452) with a literature search was performed using the PubMed, Scopus, and SciELO databases for all publications related to BS and PFD, with no language restrictions, from inception to September 2018.
Two authors screened for study eligibility and extracted data. Only prospective cohorts assessing women with morbid obesity and the prevalence of PFD before and after BS in multiple academic and private centers were included. UI, POP, and FI were defined according to the International Urogynecological Association/International Continence Society joint consensus, and diagnosis was made based on self-report or questionnaires.
Our search strategy retrieved 957 results. Of those, 28 studies were included for full analysis, and 20 studies (n = 3684 patients) were selected for final analysis. The main reasons for exclusion were missing data before and after BS (n = 7) and combined data of men and women who underwent BS (n = 1). Laparoscopic Roux-en-Y gastric bypass was the most common surgical technique. Pooled analysis (16 studies) showed that women had a mean body mass index reduction of 12.90 kg/m2 after treatment (95% confidence interval [CI], -14.82 to -10.97; p < .0001). The relative risk reduction was 67% (n = 19; odds ratio [OR], 0.33; 95% CI, 0.26–0.41; p < .0001) for UI, 52% (n = 5; OR, 0.48; 95% CI, 0.22–1.07; p = .07) for POP, and 20% (n = 9; OR, 0.80; 95% CI, 0.53–1.21; p = .29) for FI. Funnel plots for UI and FI did not suggest any publication bias. With regard to the standardized questionnaires for PFD, the International Consultation on Incontinence–Short Form, Pelvic Floor Impact Questionnaire-7 and its subscale Colorectal-Anal Impact Questionnaire-7, Pelvic Floor Distress Inventory-20, and its subscale Urinary Distress Inventory-6 showed statistically significantly lower scores. Sexual function, represented by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, showed no statistically significant improvement after surgery.
BS has a significant impact on reducing UI, but FI and POP, in obese women.</description><subject>Bariatric surgery</subject><subject>Bariatric Surgery - methods</subject><subject>Body Mass Index</subject><subject>Fecal incontinence</subject><subject>Fecal Incontinence - epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Obesity, Morbid - complications</subject><subject>Obesity, Morbid - surgery</subject><subject>Pelvic Floor - surgery</subject><subject>Pelvic Floor Disorders - epidemiology</subject><subject>Pelvic Floor Disorders - surgery</subject><subject>Pelvic organ prolapse</subject><subject>Pelvic Organ Prolapse - complications</subject><subject>Pelvic Organ Prolapse - physiopathology</subject><subject>Pelvic Organ Prolapse - surgery</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Sexual Behavior</subject><subject>Surveys and Questionnaires</subject><subject>Systematic review</subject><subject>Urinary incontinence</subject><subject>Urinary Incontinence - surgery</subject><subject>Weight Loss</subject><issn>1553-4650</issn><issn>1553-4669</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9LAzEQxYMo_ql-AQ-So5fWSdLNbsSLVquCoGg9hzSdrSm7m5rsVvrtTal6FAZmmHnz4P0IOWUwYMDkxWKwqN18wIGpAbBUYoccsiwT_aGUavdvzuCAHMW4ABA5gNwnBwJyKBgrDsnL5APpY700tqW-pDcmONMGZ-lbF-YY1tQ39AWrVdqMK-8DvV3Hsmts63xzSa_p2zq2WJs23V9x5fDrmOyVpop48tN75H18Nxk99J-e7x9H1099OwRo-zwTShaYcWmygnPg3CilWJFZkysOOQOYTYcqM0ootFaYQkkmTV4Ky9XUTEWPnG99l8F_dhhbXbtosapMg76LmrNcDVUuE5Ue4VupDT7GgKVeBlebsNYM9IakXugNSb0hqYGlEunp7Me_m9Y4-3v5RZcEV1sBppQpedDROmwszlxA2-qZd__5fwMv64Kh</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>Montenegro, Marcelo</creator><creator>Slongo, Helena</creator><creator>Juliato, Cassia Raquel Teatin</creator><creator>Minassian, Vatche Arakel</creator><creator>Tavakkoli, Ali</creator><creator>Brito, Luiz Gustavo Oliveira</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7364-4718</orcidid><orcidid>https://orcid.org/0000-0003-3197-1195</orcidid></search><sort><creationdate>201907</creationdate><title>The Impact of Bariatric Surgery on Pelvic Floor Dysfunction: A Systematic Review</title><author>Montenegro, Marcelo ; Slongo, Helena ; Juliato, Cassia Raquel Teatin ; Minassian, Vatche Arakel ; Tavakkoli, Ali ; Brito, Luiz Gustavo Oliveira</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c400t-253968e526a5822022a999185ca79207100db495a939ecc3a89616a7f3c29bab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Bariatric surgery</topic><topic>Bariatric Surgery - methods</topic><topic>Body Mass Index</topic><topic>Fecal incontinence</topic><topic>Fecal Incontinence - epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Obesity, Morbid - complications</topic><topic>Obesity, Morbid - surgery</topic><topic>Pelvic Floor - surgery</topic><topic>Pelvic Floor Disorders - epidemiology</topic><topic>Pelvic Floor Disorders - surgery</topic><topic>Pelvic organ prolapse</topic><topic>Pelvic Organ Prolapse - complications</topic><topic>Pelvic Organ Prolapse - physiopathology</topic><topic>Pelvic Organ Prolapse - surgery</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Sexual Behavior</topic><topic>Surveys and Questionnaires</topic><topic>Systematic review</topic><topic>Urinary incontinence</topic><topic>Urinary Incontinence - surgery</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Montenegro, Marcelo</creatorcontrib><creatorcontrib>Slongo, Helena</creatorcontrib><creatorcontrib>Juliato, Cassia Raquel Teatin</creatorcontrib><creatorcontrib>Minassian, Vatche Arakel</creatorcontrib><creatorcontrib>Tavakkoli, Ali</creatorcontrib><creatorcontrib>Brito, Luiz Gustavo Oliveira</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of minimally invasive gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Montenegro, Marcelo</au><au>Slongo, Helena</au><au>Juliato, Cassia Raquel Teatin</au><au>Minassian, Vatche Arakel</au><au>Tavakkoli, Ali</au><au>Brito, Luiz Gustavo Oliveira</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Impact of Bariatric Surgery on Pelvic Floor Dysfunction: A Systematic Review</atitle><jtitle>Journal of minimally invasive gynecology</jtitle><addtitle>J Minim Invasive Gynecol</addtitle><date>2019-07</date><risdate>2019</risdate><volume>26</volume><issue>5</issue><spage>816</spage><epage>825</epage><pages>816-825</pages><issn>1553-4650</issn><eissn>1553-4669</eissn><abstract>To determine the effect of bariatric surgery (BS) on the prevalence of pelvic floor dysfunctions (PFD), specifically on urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI).
A systematic review (PROSPERO registration no. CRD42017068452) with a literature search was performed using the PubMed, Scopus, and SciELO databases for all publications related to BS and PFD, with no language restrictions, from inception to September 2018.
Two authors screened for study eligibility and extracted data. Only prospective cohorts assessing women with morbid obesity and the prevalence of PFD before and after BS in multiple academic and private centers were included. UI, POP, and FI were defined according to the International Urogynecological Association/International Continence Society joint consensus, and diagnosis was made based on self-report or questionnaires.
Our search strategy retrieved 957 results. Of those, 28 studies were included for full analysis, and 20 studies (n = 3684 patients) were selected for final analysis. The main reasons for exclusion were missing data before and after BS (n = 7) and combined data of men and women who underwent BS (n = 1). Laparoscopic Roux-en-Y gastric bypass was the most common surgical technique. Pooled analysis (16 studies) showed that women had a mean body mass index reduction of 12.90 kg/m2 after treatment (95% confidence interval [CI], -14.82 to -10.97; p < .0001). The relative risk reduction was 67% (n = 19; odds ratio [OR], 0.33; 95% CI, 0.26–0.41; p < .0001) for UI, 52% (n = 5; OR, 0.48; 95% CI, 0.22–1.07; p = .07) for POP, and 20% (n = 9; OR, 0.80; 95% CI, 0.53–1.21; p = .29) for FI. Funnel plots for UI and FI did not suggest any publication bias. With regard to the standardized questionnaires for PFD, the International Consultation on Incontinence–Short Form, Pelvic Floor Impact Questionnaire-7 and its subscale Colorectal-Anal Impact Questionnaire-7, Pelvic Floor Distress Inventory-20, and its subscale Urinary Distress Inventory-6 showed statistically significantly lower scores. Sexual function, represented by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, showed no statistically significant improvement after surgery.
BS has a significant impact on reducing UI, but FI and POP, in obese women.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30708118</pmid><doi>10.1016/j.jmig.2019.01.013</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-7364-4718</orcidid><orcidid>https://orcid.org/0000-0003-3197-1195</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of minimally invasive gynecology, 2019-07, Vol.26 (5), p.816-825 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Bariatric surgery Bariatric Surgery - methods Body Mass Index Fecal incontinence Fecal Incontinence - epidemiology Female Humans Obesity, Morbid - complications Obesity, Morbid - surgery Pelvic Floor - surgery Pelvic Floor Disorders - epidemiology Pelvic Floor Disorders - surgery Pelvic organ prolapse Pelvic Organ Prolapse - complications Pelvic Organ Prolapse - physiopathology Pelvic Organ Prolapse - surgery Prevalence Prospective Studies Risk Factors Sexual Behavior Surveys and Questionnaires Systematic review Urinary incontinence Urinary Incontinence - surgery Weight Loss |
| title | The Impact of Bariatric Surgery on Pelvic Floor Dysfunction: A Systematic Review |
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