title: The impact of obesity on urinary incontinence symptoms, severity, urodynamic characteristics and quality of life.
abstract: OBJECTIVE
  We compared urinary incontinence severity measures and the impact of stress urinary incontinence in normal, overweight and obese women.
  
  
  METHODS
  Baseline characteristics of subjects in the SISTEr (655) and the TOMUS (597) were analyzed. Body mass index was defined as normal (less than 25 kg/m(2)), overweight (25 to less than 30 kg/m(2)) and obese (30 kg/m(2) or greater). Independent urinary incontinence severity measures included a 3-day diary including incontinence episode frequency, Urogenital Distress Inventory scores and Valsalva leak point pressure from urodynamic testing. Impact was measured using the Incontinence Impact Questionnaire. Multivariable regression models were fit for each severity measure (Urogenital Distress Inventory, incontinence episode frequency, Valsalva leak point pressure and Incontinence Impact Questionnaire) on weight category. Covariates included age, race, diabetes and variables significantly associated with body mass index on bivariate analysis.
  
  
  RESULTS
  Mean age (SD) of participants was 51.9 (10.3) in SISTEr and 52.9 (11.0) in TOMUS. In each trial 45% of subjects were obese. In SISTEr multivariable regression analyses showed that higher weight category was independently associated with higher mean Urogenital Distress Inventory score (p = 0.003), incontinence episode frequency (p <0.0001), Valsalva leak point pressure (p = 0.003) and Incontinence Impact Questionnaire score (p = 0.0004). In TOMUS higher weight category was not associated with Urogenital Distress Inventory score (p = 0.24) but was associated with higher incontinence episode frequency (p = 0.0003), Valsalva leak point pressure (p = 0.0006) and Incontinence Impact Questionnaire score (p <0.0001).
  
  
  CONCLUSIONS
  Obese women undergoing surgery for stress urinary incontinence report more incontinence episodes, more symptom distress and worse quality of life despite better measure of urethral function (higher Valsalva leak point pressure) on urodynamics.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA. hrichter@uabmc.edu
authors.forename: Holly E
authors.initials: HE
authors.lastname: Richter
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
authors.forename: Liyuan
authors.initials: L
authors.lastname: Huang
authors.forename: Ingrid
authors.initials: I
authors.lastname: Nygaard
authors.forename: Stephen
authors.initials: S
authors.lastname: Kraus
authors.forename: Emily
authors.initials: E
authors.lastname: Whitcomb
authors.forename: Toby C
authors.initials: TC
authors.lastname: Chai
authors.forename: Gary
authors.initials: G
authors.lastname: Lemack
authors.forename: Larry
authors.initials: L
authors.lastname: Sirls
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Dandreo
authors.forename: Anne
authors.initials: A
authors.lastname: Stoddard
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D011788:Quality of Life; D012720:Severity of Illness Index; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology*; D014563:Urodynamics