title: Urinary Incontinence Before and After Bariatric Surgery.
abstract: OBJECTIVE
  Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking.
  
  
  OBJECTIVE
  To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery.
  
  
  METHODS
  The Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012).
  
  
  METHODS
  Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter.
  
  
  METHODS
  The frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up.
  
  
  RESULTS
  Of 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m2 (range, 34-94 kg/m2), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P < .001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P < .001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P < .001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation.
  
  
  CONCLUSIONS
  Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco2Department of Epidemiology and Biostatistics, University of California, San Francisco3Department of Urology, University of California, San Francisco4S.
authors.forename: Leslee L
authors.initials: LL
authors.lastname: Subak
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Wendy C
authors.initials: WC
authors.lastname: King
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania6Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Belle
authors.affiliation: Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Jia-Yuh
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Anita P
authors.initials: AP
authors.lastname: Courcoulas
authors.affiliation: GI Metabolic and Bariatric Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Faith E
authors.initials: FE
authors.lastname: Ebel
authors.affiliation: Department of Surgery, University of Washington, Seattle.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.affiliation: Department of Surgery, University of Washington, Seattle.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Khandelwal
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: John R
authors.initials: JR
authors.lastname: Pender
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Sheila K
authors.initials: SK
authors.lastname: Pierson
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.affiliation: Department of Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Grand Forks.
authors.forename: Kristine J
authors.initials: KJ
authors.lastname: Steffen
authors.affiliation: GI Metabolic and Bariatric Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Gladys W
authors.initials: GW
authors.lastname: Strain
authors.affiliation: Department of Surgery, Oregon Health & Science University, Portland.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Wolfe
authors.affiliation: Department of Medicine, University of California, San Francisco.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D050110:Bariatric Surgery; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000601:surgery; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D015995:Prevalence; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000453:epidemiology*; D053202:Urinary Incontinence, Urge / Q000453:epidemiology*; D015431:Weight Loss; D055815:Young Adult