The Impact of Obesity on Urinary Incontinence Symptoms, Severity, Urodynamic Characteristics and Quality of Life

Received 27 May 2009 published online 16 December 2009.

Refers to article:

Body Mass Index as a Predictor of Urological Disease and Outcomes—Overly Simplistic? , 14 December 2009
Viraj A. Master
The Journal of Urology
February 2010 (Vol. 183, Issue 2, Pages 427-429)
Full Text | Full-Text PDF (113 KB)

Bladder Dysfunction in a New Mutant Mouse Model With Increased Superoxide—Lack of Nitric Oxide? , 17 December 2009
Roberto Soler, Claudius Füllhase, Baisong Lu, Colin E. Bishop, Karl-Erik Andersson
The Journal of Urology
February 2010 (Vol. 183, Issue 2, Pages 780-785)
Abstract | Full Text | Full-Text PDF (722 KB)

Purpose

We compared urinary incontinence severity measures and the impact of stress urinary incontinence in normal, overweight and obese women.

Materials and 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/m2), overweight (25 to less than 30 kg/m2) and obese (30 kg/m2 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.

Key Words: obesity, urinary incontinence, stress, urodynamics

a University of Alabama at Birmingham, Birmingham, Alabama

b Loyola University, Maywood, Illinois

c New England Research Institutes, Watertown, Massachusetts

d University of Iowa, Iowa City, Iowa

e University of Texas Health Science Center at San Antonio, San Antonio

f University of Texas Southwestern, Dallas, Texas

g University of California at San Diego, San Diego, California

h University of Maryland, Baltimore, Maryland

i William Beaumont Hospital, Royal Oak, Michigan

Correspondence: 618 20th St. South, NHB 219, Birmingham, Alabama 35233 (telephone: 205-934-1704; FAX: 205-975-8893)

Supported by cooperative agreements U01 DK58225, U01 DK58229, U01 DK58234, U01 DK58231, U01 DK60379, U01 DK60380, U01 DK60393, U01 DK60395, U01 DK60397 and U01 DK60401 from the National Institute of Diabetes and Digestive and Kidney Diseases.

See Editorial on page 427.

For another article on a related topic see page 780.

† Financial interest and/or other relationship with Xanodyne and Pfizer.

‡ Financial interest and/or other relationship with Intuitive Surgical.

§ Financial interest and/or other relationship with Pfizer and Laborie Medical Technologies.

∥ Financial interest and/or other relationship with Pfizer, Allergan and National Institutes of Health.

¶ Financial interest and/or other relationship with Pfizer, Astellas, Novartis and Allergan.

⁎⁎ Financial interest and/or other relationship with Elan Corporation, Johnson & Johnson, Stryker, Bristol-Myers Squibb and Procter & Gamble.

PII: S0022-5347(09)02624-X

doi:10.1016/j.juro.2009.09.083

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