PROSPECTIVE EVALUATION OF URINARY INCONTINENCE IN MORBIDLY OBESE ADOLESCENTS PRESENTING FOR WEIGHT LOSS SURGERY
William R. DeFoor, Jr., MD, MPH1, Elizabeth Jackson, MD1, Changchun Xie, PhD1, Todd Jenkins, PhD, MPH1, Linda Kollar, RN1, Ralph Buncher, MD2, Anita Courcoulas, MD3, Marc Michalsky, MD4, Mary Brandt, MD5, Thomas Inge, MD, PhD1.
1Cincinnati Children's Hospital, Cincinnati, OH, USA, 2University of Cincinnati, Cincinnati, OH, USA, 3University of Pittsburgh, Pittsburgh, PA, USA, 4Nationwide Children's Hospital, Columbus, OH, USA, 5Texas Children's Hospital, Houston, TX, USA.
Background: Obesity has been associated with daytime urinary incontinence (UI) likely due to increased intra-abdominopelvic pressure. The purpose of this study was to assess baseline and 3 year incontinence symptoms in severely obese adolescents who underwent bariatric surgery.
Methods: Teen-LABS study is a prospective, multicenter study designed to evaluate efficacy and safety of bariatric surgery in adolescents. Consecutive adolescents (aged ≤19 years of age) undergoing bariatric surgery at five centers between 2007 and 2011 were enrolled. Baseline and post-operative anthropometric and clinical data were collected by trained study staff. Prevalence and severity of UI were determined by standardized interview questionnaire. A logistic regression model was used to identify predictors of UI.
Results: A total of 242 subjects (76% female) were evaluated at baseline. Only 4 participants were lost to follow-up; however, 15% of visits and 22% of data points were missing at the 3 year follow-up. The mean age was 17.1 years at baseline. 72% of patients were white race. The pre-operative median body mass index (BMI) was 50.5 kg/m2. At presentation, 18% of females and 7% of males reported urinary incontinence. Univariate analyses at baseline indicated incontinence status differed significantly by gender (p<0.05), but was similar in terms of age, race, weight, diabetes status, and pannus grade (Table 1). Multiple logistic regression analysis at baseline indicated that a significant gender-by-diabetes interaction was present. Specifically, in those without Type II diabetes, females were significantly more likely to have UI than males (OR 9.1, p=0.03). Males with diabetes were more likely to have UI than those males without diabetes (OR 20.6, p=0.01). Males with diabetes were also more likely to have UI than females, but this did not reach statistical significance (OR 1.5, p=0.6). Females with diabetes had similar rates of UI to those females without diabetes. Table 2 shows incontinence rates at selected time points in the study. The incontinence prevalence in females and males decreased from 18% and 7% at baseline to 7% and 0% at six months after surgery, respectively (p<0.01). The continence rate remained stable at 36 months post-operatively.
Conclusions: In adolescents undergoing bariatric surgery, urinary incontinence was more common in females than males. Males with diabetes were more likely to have UI than males without diabetes. Incontinence status significantly improved by 6 months and was durable to 3 years following surgery.
| Total (N=242) | Incontinence (N=35) | No Incontinence (N=207) | P-value | |
| Female, n(%) | 183 (76) | 31 (89) | 152 (73) | 0.05 |
| Age (years), Mean | 17.1 | 17.1 | 17.1 | 1.00 |
| White race, n (%) | 174 (72) | 28 (80) | 146 (71) | 0.25 |
| BMI (kg/m2), Median (IQR) | 50.5 (45,58) | 49.4 (45.2,61.4) | 50.7 (45.2,57.8) | 0.92 |
| Diabetes, n (%) | 33 (14) | 8 (23) | 25 (12) | 0.11 |
| Pannus Grade 3+, n (%) | 55 (23) | 8 (23) | 47 (23) | 1.00 |
| Incontinence episodes | Baseline (%) | 6 months (%) | 12 months (%) | 36 months (%) | |
| Females | |||||
| Never | 64 | 72 | 77 | 73 | |
| Weekly | 9 | 6 | 4 | 6 | |
| Daily | 9 | 2 | 1 | 2 | |
| Males | |||||
| Never | 81 | 96 | 96 | 88 | |
| Weekly | 5 | 0 | 1 | 0 | |
| Daily | 2 | 0 | 0 | 0 | |
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