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Keywords:

  • obesity;
  • bariatric surgery;
  • laparoscopic gastric banding surgery;
  • urinary incontinence;
  • erectile function;
  • sexual function

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING AND CONFLICT OF INTEREST
  8. ACKNOWLEDGEMENTS
  9. CONFLICT OF INTEREST
  10. REFERENCES

Study Type – Symptom prevalence (non-consecutive cohort) Level of Evidence 4

What’s known on the subject? and What does the study add?

Obesity is a known risk factor for Urinary Incontinence. Non surgical weight loss has been shown to reduce Urinary Incontinence, but there is only limited evidence for surgically induced weight loss. This study aims to clarify the effects of surgically induced weight loss on urinary and erectile function.

OBJECTIVE

To investigate the effects of weight loss and time post laparoscopic gastric banding surgery (LGB) on urinary and sexual function.

MATERIALS AND METHODS

653 females and 145 males who underwent LGB over the last 10 years at a single centre in Australia were contacted by post and asked to complete validated questionnaires.

RESULTS

The pre-surgery body-mass index (BMI) was higher in males than females (47.3 vs 43.5); 65% of the females and 24% of males previously had some degree of urinary incontinence (UI). There were significant weight and BMI losses in males and females (23.2 kg and 7.51 vs 22.7 kg and 8.28; P < 0.0001). In females there were significant improvements in the ICIQ-SF (P= 0.0008) and Quality of Life (P < 0.0001) scores. For each kilogram lost there was a 0.05 improvement in the ICIQ score (P= 0.03) in females. There were also postoperative improvements in all symptoms of UI and stress incontinence in females but urge incontinence worsened, when adjusted for weight loss. In males there was no improvement in UI with weight loss after LGB. There was no relationship with time and UI in either gender; 83.3% of males reported a degree of ED before LGB. There was improvement in the IIEF score in males post LGB but there was worsening of erectile index (P= 0.005) and orgasmic function (P= 0.002) when adjusted for time. More males had started using phosphodiesterase type 5 inhibitors, post-LGB.

CONCLUSIONS

Surgically induced weight loss by LGB improved overall UI, quality of life and stress incontinence in females but urge incontinence worsened. There was no improvement in UI with weight-loss or overall sexual function after LGB in males. However, erectile index and orgasmic function worsened when adjusted for time. Further evaluation is required by means of larger prospective studies involving urodynamic testing.


Abbreviations
BMI

body-mass index

ICIQ

International Consultation on Incontinence Questionnaire

IPSS

International Prostate Symptom Score

LGB

laparoscopic gastric banding surgery

UI

urinary incontinence

INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING AND CONFLICT OF INTEREST
  8. ACKNOWLEDGEMENTS
  9. CONFLICT OF INTEREST
  10. REFERENCES

Obesity is an increasing problem worldwide with an estimated 1.6 billion adults categorized as overweight and 400 million as obese. Its associations with cardiovascular disease, hypertension, diabetes, cancer and musculoskeletal disease have a significant effect on the global disease burden. In Europe alone, obesity accounts for 2–8% of the healthcare costs and 10–13% of deaths [1]. In Australia, 68% of males and 55% of females were found to be overweight or obese in 2007–08 [2]. There has been an increase in this trend over the years and in 2005 it was responsible for costing the Australian society and government £21billion [3].

Urinary incontinence (UI) is also a feature attributable to obesity [4–14]. In an Australian household survey, 24.4% of the population, 25% of all women and 10.1% of men (24.4% of the population) suffered from some degree of urge incontinence, and 20.5% (females) and 4.3% (males) were in the 20- to 49-year age group [15]. Urinary incontinence has a huge burden on the economy accounting for 31 526 healthy life years lost in 2006 [15] and approximately $710 million spent in 1998 [16].

Weight loss has shown to improve urinary symptoms [4,5,7–14]. Several studies have demonstrated the improvement in urinary symptoms in females with non-surgical weight loss [7,8]. A randomized controlled trial showed a 47% mean decrease in the number of episodes of UI per week with exercise and diet induced mean weight loss of 7.8 kg in 6 months (P= 0.01) [7]. Interestingly, bariatric surgery is also shown to improve UI in women [9–14]. However, the existing data is limited, especially in males.

Another feature associated with obesity in males is erectile dysfunction. There are only a few studies which have analysed the effects of erectile function by weight loss from bariatric surgery, with conflicting results [17,18].

The aims of this study were to analyse the UI data in both males and females and erectile function in males after laparoscopic gastric banding surgery (LGB), over a period of 10 years and to examine the effects of weight loss on urinary function by using validated questionnaires. We also wished to analyse the relationship between time from surgery and symptoms of BPH after weight loss by LGB.

METHODS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING AND CONFLICT OF INTEREST
  8. ACKNOWLEDGEMENTS
  9. CONFLICT OF INTEREST
  10. REFERENCES

This retrospective study was approved by the Hunter area ethics committee and it was decided to use anonymity for this part of the study from the onset, to respect the patients’ privacy, especially considering the nature and the sensitivity of the questions. Therefore, only initial contact by post was made. This is further justified by carrying out an additional prospective study considering the health economic importance of the subject matter.

International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and International Prostate Symptom Score (IPSS) questionnaires were mailed to all patients who underwent LGB between January 2001 and 2009 at one surgical practice in Newcastle, Australia. Both the questionnaires have been validated, reliable [19–22] and widely used in analysing urinary function in both males and females [23], with the IPSS validated in examining male prostatic symptoms [22]. Another validated, reliable and widely used questionnaire the International Index of Erectile Function (IIEF) questionnaire [24] was included with the other two questionnaires for males. Further questions were included to enquire about any additional surgery or medications that the patient had received and which may have affected the patient’s urinary function before or after their LGB and their weight and height before and after LGB.

Thus, each of the 653 females received two sets and the 145 males, three sets, of the above questionnaires: inquiring about their perception of urinary symptoms before and after surgery. A stamped return envelope was also included and all answers were made anonymous.

The ICIQ-SF scores were analysed to examine the change in urinary function with surgery. The type of incontinence was further examined using the ICIQ-SF question 6. This question, which asks ‘when does urine leak’, has been previously validated as being comparable to urodynamic testing to identify the type of incontinence [21]. The Quality of Life (QOL) question in the IPSS questionnaire, ‘If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that? ’ was used to analyse the impact of urinary function on daily living. Incomplete emptying, frequency, urgency and nocturia questions were used from the IPSS questionnaire to further analyse the symptoms, in both sexes. The IPSS score was also used in males to examine if the incontinence symptoms were caused by prostatic symptoms and IIEF scores were used to examine the erectile function.

Statistical analysis

The statistical analysis was carried out by the research design and statistical support unit within the School of Medicine and Public Health at the University of Newcastle. Paired t-tests were used to determine if there had been a statistically significant change in weight, body-mass index (BMI) and individual questionnaire scores after LGB. Analysis of covariance (ancova) was used to determine if change in UI symptoms and erectile function symptoms after LGB was associated with weight change after adjusting for age and time since surgery. A further univariate analysis using the McNemars test was used to determine if there had been a statistically significant change in type of incontinence before and after LGB.

RESULTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING AND CONFLICT OF INTEREST
  8. ACKNOWLEDGEMENTS
  9. CONFLICT OF INTEREST
  10. REFERENCES

Of the total questionnaires mailed, 160 of 653 females and 36 of 145 males responded. An additional 73 females and 17 male questionnaires were returned unanswered because patients had moved with no forwarding address and therefore removed from the total number to provide response rates of 27.59% in females and 28.12% in males. Eighteen females and two males were excluded from the study because they had surgery or were on medication for urinary or sexual function. Therefore, the data for 142 females and 34 males were analysed in the study.

The males (mean 52.8 years) were older than the females (mean 47.8 years) in the study group. The males also had a higher mean preoperative weight (145.6 kg) and BMI (47.3) than the females (118.3 kg and 43.5). The time since surgery was similar in both groups (31.79 months and 31.82 months) (Table 1). In this study group 65% (n= 92) of females and 24% (n= 8) of males had some degree of UI pre surgery.

Table 1.  Summary of demographic and weight related measures
VariableGender
Male (n= 34)Female (n= 142)
  1. BMI, body-mass index.

Age (years) 52.8 (9.33) 47.8 (10.98)
Height (m)  1.77 (0.104)  1.66 (0.083)
Time Since Surgery (months) 31.79 (22.27)- 31.81 (24.42)
Weight before surgery (kg)145.6 (28.31)118.3 (18.50)
Weight after surgery (kg)123.3 (23.15) 96.7 (18.48)
Weight loss (kg) 23.2 (18.30) 22.7 (15.74)
BMI loss (kg/m2)  7.51 (5.783)  8.28 (5.784)

There was a significant weight loss in both males and females after LGB. The males had a greater weight loss than females (23.2 kg vs 22.7 kg), but females had a greater BMI loss (7.51 vs 8.28). In females, the ICQ-SF (P= 0.0008) and QOL (P < 0.0001) symptoms both significantly improved after LGB. However, there was no improvement in urinary function despite weight loss after LGB in males (Table 2).

Table 2.  Summary of pre-surgery and post-surgery values and change by gender
Outcome of interestGenderMean (SD) of outcomesP
BeforeAfterChange
  1. ICIQ, International Consultation on Incontinence Questionnaire; IPSS, International Prostate Symptom Score; IIEF, International Index of Erectile Function; N/A, not assessed.

Weight (kg)Male145.6 (28.31)123.3 (23.19)−23.1 (18.35)<0.0001
Female 118.3 (18.50)96.7 (18.48)−22.7 (15.74)<0.0001
Body mass index (kg/m2)Male47.3 (12.67)38.4 (6.18)−7.51 (5.78)<0.0001
Female43.5 (6.65)35.5 (6.80)−8.28 (5.78)<0.0001
ICIQMale1.82 (3.43)1.67 (3.59)0.40 (3.55)0.5418
Female5.24 (5.05)3.93 (4.83)−1.30 (4.34)0.0008
Quality of lifeMale1.56 (1.52)1.50 (1.54)−0.06 (1.35)0.8006
Female2.48 (1.94)1.79 (1.78)−0.72 (1.72)<0.0001
Urinary frequency (IPSS)Male1.35 (1.57)1.62 (1.69)0.26 (0.90)0.0951
Female1.60 (1.61)1.24 (1.42)−0.39 (1.42)0.0032
Incomplete emptying (IPSS)Male0.53 (1.02)0.62 (1.13)0.09 (0.51)0.3246
Female0.93 (1.33)0.67 (1.05)−0.25 (1.28)0.0298
Nocturia (IPSS)Male1.88 (1.55)1.79 (1.49)−0.09 (0.93)0.5851
Female1.98 (1.63)1.62 (1.57)−0.37 (1.01)<0.0001
Urge (IPSS)Male1.03 (1.36)1.09 (1.33)0.06 (0.74)0.6443
Female1.66 (1.72)1.27 (1.53)−0.36 (1.38)0.0044
IPSS total scoreMales6.87 (6.21)6.90 (5.70)−0.030.9632
FemaleN/AN/AN/AN/A
IIEF (total)Male51.36(22.17)48.17 (25.34)−1.000.7012
FemaleN/AN/AN/AN/A

On the multivariate analysis of the weight and time, the model showed that in females for every kilogram weight lost, the ICIQ score is on average 0.05 lower. (P= 0.0343). However, there was no improvement in males after weight loss. The time since surgery had no relationship with the ICIQ score post-surgery in females and males (Table 3).

Table 3.  International Consultation on Incontinence Questionnaire (ICIQ) scores when adjusted for weight loss and time by ancova (weight loss change is pre-/post-surgery so losses are positive)
GenderCovariatesStatistics
Estimate95% Confidence IntervalP
Female (n= 97)Weight change (kg)−0.05(−0.1, 0)0.0362
Time (months)0.03(0, 0.06)0.0624
Pre-surgery ICIQ Score0.61(0.46, 0.76)<0.0001
Male (n= 20)Weight change (kg)0.00(−0.12, 0.11)0.9620
Time (months)0.02(−0.07, 0.1)0.6996
Pre-surgery ICIQ score0.48(−0.1, 1.06)0.1027

Using the ancova model with the QOL as the outcome, the weight change seems to strongly trend toward an improvement in QOL. However, no relationship was seen between time since surgery and QOL in males and females. There was also no relationship between QOL and change in weight in males (Table 4).

Table 4.  Quality of Life (QOL) scores when adjusted for weight and time by ancova
GenderCovariatesStatistics
Estimate95% Confidence IntervalP
Female (n= 89)Weight change (kg)−0.02(−0.04, 0)0.1027
Time (months)0.01(0, 0.02)0.1933
Pre-surgery QOL score0.53(0.38, 0.69)<0.0001
Male (n= 20)Weight change (kg)0.00(−0.04, 0.03)0.9115
Time (months)0.00(−0.02, 0.03)0.7438
Pre-surgery QOL score0.85(0.49, 1.22)<0.0001

On examination of individual symptoms, the females had higher preoperative rates of frequency, urgency, incomplete emptying and nocturia, and there were significant improvements in all these symptoms after LGB in females (Table 2). However, none of the symptoms had a significant improvement in either gender when adjusted for weight loss or time (Table 5).

Table 5.  Results of ancova models with various incontinence symptoms as the outcomes
SymptomStrataCovariatesStatistics
Estimate95% Confidence IntervalP
  1. IPSS, International Prostate Symptom Score.

Urinary FrequencyFemale (n= 89)Weight change (kg)0.00(−0.02, 0.01)0.8323
Time (months)0.00(−0.01, 0.01)0.4175
Pre-surgery IPSS Frequency0.49(0.34, 0.64)<0.0001
Male (n= 20)Weight change (kg)0.00(−0.03, 0.02)0.8238
Time (months)0.00(−0.01, 0.02)0.6452
Pre-surgery IPSS Frequency0.85(0.61, 1.09)<0.0001
Incomplete EmptyingFemale (n= 89)Weight change (kg)0.00(−0.01, 0.01)0.9453
Time (months)0.00(−0.01, 0)0.2866
Pre-surgery IPSS Incomp0.17(0.03, 0.32)0.0174
Male (n= 20)Weight change (kg)0.00(−0.02, 0.02)0.8920
Time (months)0.00(−0.01, 0.01)0.9647
Pre-surgery IPSS Incomp0.99(0.75, 1.23)<0.0001
NocturiaFemale (n= 89)Weight change (kg)0.00(−0.01, 0.02)0.7287
Time (months)0.01(0, 0.02)0.0677
Pre-surgery IPSS Nocturia0.78(0.66, 0.9)<0.0001
Male (n= 20)Weight change (kg)−0.01(−0.04, 0.02)0.4942
Time (months)0.00(−0.01, 0.02)0.6840
Pre-surgery IPSS Nocturia0.72(0.45, 1)<0.0001
UrgencyFemale (n= 88)Weight change (kg)−0.01(−0.02, 0.01)0.4387
Time (months)0.01(0, 0.02)0.2792
Pre-surgery IPSS Urgency0.56(0.42, 0.71)<0.0001
Male (n= 20)Weight change (kg)0.00(−0.03, 0.02)0.7813
Time (months)0.01(0, 0.03)0.1516
Pre-surgery IPSS Urgency0.65(0.36, 0.95)<0.0001

In analysis of the type of incontinence in females after LGB, there was a significant improvement in stress incontinence (P= 0.0164) and a strong trend towards improvement when adjusted for weight loss (P= 0.0921) (Table 6).

Table 6.  The number of women and men with ‘stress incontinence’ before and after surgery
FemalesStress afterP
+
Stress beforeFrequency96 50.0164*
+Frequency1622
Males+ 
  • *

    P= 0.0921 after adjusting for weight; −, denotes no symptoms; +, denotes presence of symptoms.

Stress beforeFrequency320 
+Frequency 00

In females, there was no improvement in urge incontinence after LGB, but when adjusted for weight loss after surgery, there was a worsening of symptoms (P= 0.0357). In males, there was no change in urge incontinence symptoms (Table 7).

Table 7.  The number of women and men with ‘urge incontinence’ before and after surgery
FemalesUrge afterP
+
Urge beforeFrequency118100.1088*
+Frequency  4 7
Males+ 
  • *

    P= 0.0357 after adjusting for weight (i.e. significantly more urge incontinence is being developed after surgery);

  • P= 0.3527 after adjusting for weight; −, denotes no symptoms; +, denotes presence of symptoms.

Urge beforeFrequency2411.0000
+Frequency 16

Erectile function

Preoperatively, 83.3% of males had erectile dysfunction and one person was using phosphodiesterase type 5 inhibitors (PDE5-I). There was no improvement in the total IIEF score despite a significant weight loss after LGB (Table 2). This was confirmed in the multivariant analysis, where there was no improvement in any of the domains of IIEF when adjusted for weight loss. Surprisingly, there was a trend towards worsening of erectile function and orgasmic function with time but not with age. This was more evident when analysed for percentage excess weight loss, where there was worsening of the score by 0.13 (P= 0.005) in erectile function and 0.06 (P= 0.002) in orgasmic function with time (Table 8). There were also five further males who had started using PDE5-I.

Table 8.  Results of ancova models in International Index of Erectile Function (IIEF) with various symptoms as the outcomes
SymptomCovariatesStatistics
Estimate95% Confidence IntervalP
  1. BMI, body-mass index.

Erectile function (n= 17)Age (years)0.10(−0.24, 0.45)0.5564
Time (months)−0.13(−0.26, 0)0.0533
% Excess BMI loss0.02(−0.07, 0.11)0.6953
Pre-surgery erectile function score0.95(0.61, 1.29)<0.0001
Orgasmic function (n= 17)Age0.11(0.01, 0.21)0.0314
Time (months)−0.06(−0.1, −0.02)0.0020
% Excess BMI loss0.02(−0.01, 0.04)0.1925
Pre-surgery orgasmic function score1.17(0.89, 1.45)<0.0001
Sexual desire (n= 17)Age (years)−0.03(−0.09, 0.03)0.2735
Time (months)−0.02(−0.04, 0)0.0887
% Excess BMI loss0.01(0, 0.03)0.0605
Pre-surgery sexual desire score0.79(0.54, 1.04)<0.0001
Intercourse satisfaction (n= 17)Age (years)−0.09(−0.31, 0.12)0.3955
Time (months)−0.04(−0.13, 0.05)0.3596
% Excess BMI loss0.00(−0.06, 0.06)0.9457
Pre surgery intercourse satisfaction score0.63(0.25, 1.01)0.0011
Overall satisfaction (n= 17)Age (years)−0.02(−0.16, 0.13)0.8180
Time (months)−0.03(−0.09, 0.03)0.2834
% Excess BMI Loss0.01(−0.02, 0.04)0.6118
Pre-surgery overall satisfaction score0.65(0.25, 1.05)0.0015

DISCUSSION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING AND CONFLICT OF INTEREST
  8. ACKNOWLEDGEMENTS
  9. CONFLICT OF INTEREST
  10. REFERENCES

Urinary incontinence in females

Obesity has been identified as a risk factor for UI in females [5], especially stress incontinence. The females in our study group had a mean pre-LGB weight of 118.3 kg and a mean BMI of 43.5. Of this group 64.52% had had some degree of UI, in keeping with some of the reported rates of UI in morbidly obese females (32–66.9%) [6,11].

We found that a mean reduction of 22.7 kg in weight or BMI loss of 8.28 after LGB contributed to a significant improvement in urinary symptoms and quality of life in females. In addition, we noted an improvement in ICIQ-SF score by 0.05 with every kilogram of weight loss in the females in our study post-LGB, thereby confirming the impact of weight loss on UI in females after LGB. It is postulated that this maybe caused by a reduction in intra-abdominal pressure, as suggested by Bump et al. [9] and Cummings and Rodning [5].

A few other studies have examined the relationship between bariatric surgery and UI. Bump et al. [9] examined 12 obese women who underwent gastric bypass surgery by means of questionnaires and urodynamic testing. Of these, only three patients continued to have urinary symptoms postoperatively [9]. Karuba et al. [11] also reported that 50% of the 38 obese females who underwent bariatric surgery (majority gastric bypass surgery) had resolution of symptoms post operatively at >6 months. Their mean urinary severity index score improved from 5.4+/12.3 to 2.3+/−2.8 [11]. Deitel et al. [13] examined 138 females who had lost >50% of their excess body weight after bariatric surgery and reported an improvement of urinary stress incontinence from 61.2% to 11.6% (P= 0.001).

Laungani et al. [12] investigated a group of 58 females who had LGB and reported a resolution of symptoms in 64% and improvement in 92% at 12 months. They also identified an improvement in the ICIQ-SF scores from 7.6 ± 4 preoperatively to 3.0 ± 4 at 3 months and 1.8 ± 4 at 12 months (P < 0.001) [12]. The QOL score on the ICIQ-SF also improved from 3.2 ± 3 to 0.4 ± 2 (P < 0.001) at 1 year [12]. These results are comparable to our findings.

Although there were significant improvements in nocturia, urinary frequency, incomplete emptying and urgency in females after LGB, the significance was lost when adjusting for weight. Similarly, stress incontinence was also seen to significantly improve after LGB in the females in our study. Although the significance of these is lost after adjusting for weight loss, the trend remained, suggesting that stress incontinence improves after LGB. These results may be arise from the loss of statistical power caused by a number of respondents not filling the preoperative and postoperative weights in the questionnaires. This Improvement in stress incontinence is also a feature seen with surgical [13] and non-surgical [7,8] weight loss. The reasons are as discussed earlier.

Surprisingly, urge incontinence in our study worsened when adjusted for weight after LGB. Subak et al. [7] reported improvement of urge UI after non-surgical weight loss. Causes of urge incontinence are multifactorial and one reason for the worsening symptoms could be the effect of time, rather than weight loss.

Time did not seem to have an effect on urinary function after LGB in our study. Urinary function is shown to improve as early as 3 months [12] to 4 months [11] after LGB. The maximum weight loss after LGB is thought to be achieved at around 2 years and is much faster than gastric bypass surgery. Therefore, as the effects of LGB are seen early, the relationship with UI and time would be lost after 2 years, in keeping with our findings.

Urinary incontinence in males

UI in males is a poorly investigated and understood area and the main causes are thought to be due to age, benign prostatic hypertrophy, functional and cognitive impairment, neurological diseases and secondary to TURP [4].

There is some reported evidence for the association between obesity and BPH, with the latter causing UI in males [4]. Although the mechanism is unclear, some of the postulated reasons for the increased prostate volume were increased oestrogen/testosterone, fasting glucose and hyperinsulinaemia in obese males [25]. Kirstal et al. [26] studied 5667 patients and found a 0.05 increase in the waist-hip ratio which accounted for 10% increase in the total BPH and severe BPH symptoms by using the IPSS questionnaire. They suggested weight loss to be useful in the management of BPH symptoms [26]. However, we found no evidence to suggest improvement in the IPSS score with surgical weight loss in our study.

Although 23.54% of males reported UI before LGB, we could not identify an association between weight loss and UI. Therefore, features such as raised intra-abdominal pressure may not be attributed to UI in males.

Erectile function in males

Obesity and insulin resistance (which form the definition of metabolic syndrome) have been identified as causes of peripheral vascular disease as a result of endothelial dysfunction and atherosclerosis [27,28]. Endothelial dysfunction and atherosclerosis have also been identified as a risk factor for erectile dysfunction [28–31].

Improvement in sexual function was seen after non-surgical weight loss [32,33]. The proposed mechanisms include improvement in insulin resistance, hypogonadism and hypertension [28]. Bariatric surgery also improved insulin resistance by means of weight reduction [34] and therefore erectile dysfunction was expected to improve after LGB. However, the evidence for erectile function in males after bariatric surgery is controversial.

Our results did not show an improvement in sexual function and there was a worsening of erectile function and orgasmic function after LGB, with 5 out of 34 males using PDE5-I. However, Dallal et al. [17] demonstrated significant improvement in all aspects of the Brief Sexual Inventory (BSI) in 95 men who underwent gastric bypass surgery at a mean of 19 months (P < 0.0005 in all aspects). They also went on to show that erectile function normalized for most patients when compared with a normal age-matched male [17].

Contrary to Dallal et al. [17], Di Frega et al. [18] demonstrated, in their study, that six males who also underwent gastric bypass developed erectile dysfunction and infertility. Reduced absorption of nutrients especially zinc, after gastric bypass surgery, has been hypothesized as the cause for this [18]. However, no malabsorption has been demonstrated after LGB. It is known that LGB causes weight loss by a restrictive mechanism and therefore the worsening of symptoms seen in our study may be caused by time and the ageing process. We could not find any studies that examined erectile function in males after LGB, warranting further prospective evaluation.

The main limitations of this study were the retrospective nature and poor response rates. Being a retrospective study, this may have allowed recall bias, and the use of questionnaires based on subjective assessment could have also reflected factors such as individual patient satisfaction with the surgery. The length of the questionnaires, especially in males may have contributed to the poor response rate as they had two sets of ICIQ-SF, IPSS and IIEF questionnaires to complete. Although a screening question was included to identify any medication or surgery that might affect urinary or sexual function, there may be other factors that affected the results such as parity and menopausal status. These factors were excluded in order to simplify and to minimize the questionnaires the questionnaires. The majority of these limitations have been anticipated at the initial study design and rectified by means of carrying out a concurrent prospective study (currently in progress) because of the health economic importance of the subject matter.

Conclusions

Urinary incontinence is common in the morbid obese population. Surgical weight loss improved overall UI, quality of life and stress incontinence in women. Males showed no significant improvement in UI with surgically induced weight loss in males. While erectile function also did not improve after LGB, it trended towards worsening with time. More prospective studies involving urodynamic evaluation are needed to investigate the effects of bariatric surgery on urinary and sexual function in males and females in depth.

FUNDING AND CONFLICT OF INTEREST

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING AND CONFLICT OF INTEREST
  8. ACKNOWLEDGEMENTS
  9. CONFLICT OF INTEREST
  10. REFERENCES

Funding for stationary and statistical analysis provided by Allergan Australia.

No conflict of interest.

ACKNOWLEDGEMENTS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING AND CONFLICT OF INTEREST
  8. ACKNOWLEDGEMENTS
  9. CONFLICT OF INTEREST
  10. REFERENCES

We thank Miss Sally Norton from Southmead Hopital, Bristol for all her guidance and advice and Professor Paul Abrams and Dr Nikki Cotterill from the Bristol Urology Institute for their help and guidance with the questionnaires.

CONFLICT OF INTEREST

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING AND CONFLICT OF INTEREST
  8. ACKNOWLEDGEMENTS
  9. CONFLICT OF INTEREST
  10. REFERENCES

None declared. Source of funding for stationary and statistical analysis: Allergan, Australia.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. METHODS
  5. RESULTS
  6. DISCUSSION
  7. FUNDING AND CONFLICT OF INTEREST
  8. ACKNOWLEDGEMENTS
  9. CONFLICT OF INTEREST
  10. REFERENCES
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