title: Pelvic support and urinary function improve in women after surgically induced weight reduction.
abstract: OBJECTIVE
  : The objective of this study was to assess pelvic organ support and symptoms in morbidly obese women before and after weight reductive surgery.
  
  
  METHODS
  : Fifty-four women were enrolled in this institutional review board-approved protocol. Data collection at baseline and 6 months following surgery included a Pelvic Organ Prolapse Quantification examination, questionnaires including the Pelvic Floor Distress Inventory, the Pelvic Floor Impact Questionnaire, and the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire short form, and a 3-day voiding diary. Before-surgery and after-surgery measures were compared using paired Student t tests for continuous, normally distributed data or the Wilcoxon signed rank test for ordinal data.
  
  
  RESULTS
  : Baseline and 6-month data were available for 34 women. The mean body mass index was 46 ± 6 kg/m at baseline and 33 ± 6 kg/m after 6 months. Subjects with ≥stage 2 prolapse at baseline demonstrated an improvement of 0.5 cm (baseline, 0.9 ± 0.8 cm; after 6 months, -1.4 ± 0.9 cm) in the anterior vaginal compartment (points Aa/Ba) 6 months following weight reductive surgery (P = 0.05). Of 24 women who completed 3-day voiding diaries, 12 were incontinent at baseline with a median number of incontinent episodes of 6.5 per day (range, 3-34). After surgery, 6 incontinent women became continent. In the 6 women who remained incontinent after surgery, the number of incontinent episodes per day decreased by a median of 2.5 (range, 1-11). Pelvic Floor Distress Inventory scores improved following weight reduction (baseline, 115 ± 80; after 6 months, 58 ± 70; P < 0.01).
  
  
  CONCLUSIONS
  : Obese women, after surgically induced weight loss, demonstrate an improvement in anterior vaginal support, urinary leakage and pelvic floor symptoms.
authors.affiliation: From the *Division of Urogynecology and Female Pelvic Surgery, Department of Obstetrics and Gynecology, Howard University Hospital, Howard University College of Medicine, Washington, DC; and †Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: James A
authors.initials: JA
authors.lastname: Daucher
authors.forename: Rennique E
authors.initials: RE
authors.lastname: Ellison
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Lowder