Urinary incontinence in obese women

Abstract

In recent decades, obesity has assumed the features of a pandemic. Leading to the development of many complications, obesity also contributes to the development of urinary incontinence. The review presents current data on the etiology, pathophysiology and approaches to the treatment of stress urinary incontinence in obese patients. There are a large number of publications by foreign authors on the problem of urinary incontinence in patients with obesity. The results of the studies allow us to say with confidence about the direct relationship between an increase in body mass index and the risk of developing urinary incontinence. Long-term results of surgical treatment of urinary incontinence in obese patients require reflection and further observation. It is noteworthy that this problem is practically not reflected in the works of domestic authors. It is relevant to conduct domestic clinical studies on the problems of urinary incontinence in patients with obesity.

Keywords

obesity / urinary incontinence in women / surgical treatment / bariatric surgery

References

[1] Obesity: preventing and managing the global epidemic: report of a WHO Consultation on Obesity, Geneva, 3–5 June 1997. 276 p. World Health Organization. Available from: https://apps.who.int/iris/handle/10665/63854. Accessed: 2023 Aug. 10.

[2] World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO Consultation on Obesity, Geneva, 3–5 June 1997. 276 p. Режим доступа: https://apps.who.int/iris/handle/10665/63854. Дата обращения: 10.08.2023.

[3] European Charter on counteracting obesity: WHO European Ministerial Conference on Counteracting Obesity: Diet and physical activity for health: Istanbul, Turkey, 15–17 November WHO; 2006. 5 p. Available from: https://apps.who.int/iris/handle/10665/107801. Accessed: 2023 Aug. 10.

[4] European Charter on counteracting obesity: WHO European Ministerial Conference on Counteracting Obesity: Diet and physical activity for health: Istanbul, Turkey, 15–17 November 2006. Режим доступа: https://apps.who.int/iris/handle/10665/107801. Дата обращения: 10.08.2023.

[5] Obesity and overweight. World Health Organization report. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed: 2023 Sept. 02.

[6] Obesity and overweight. World Health Organization report. Режим доступа: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Дата обращения: 02.09.2023

[7] Rabin BA, Boehmer TK, Brownson RC. Cross-national comparison of environmental and policy correlates of obesity in Europe. Eur J Public Health. 2007;17(1):53–61. DOI: 10.1093/eurpub/ckl073

[8] Rabin B.A., Boehmer T.K., Brownson R.C. Cross-national comparison of environmental and policy correlates of obesity in Europe // Eur J Public Health. 2007. Vol. 17, No. 1. P. 53–61. DOI: 10.1093/eurpub/ckl073

[9] Ramalingam K, Monga A. Obesity and pelvic floor dysfunction. Best Pract Res Clin Obstet Gynaecol. 2015;29(4):541–547. DOI: 10.1016/j.bpobgyn.2015.02.002

[10] Ramalingam K., Monga A. Obesity and pelvic floor dysfunction // Best Pract Res Clin Obstet Gynaecol. 2015. Vol. 29, No. 4. P. 541–547. DOI: 10.1016/j.bpobgyn.2015.02.002

[11] Sazonova NA, Kiseleva MG, Gadzhieva ZK, Gvozdev MY. Urinary incontinence in women and its impact on quality of life. Urologiia. 2022;(2):136–139. (In Russ.) DOI: 10.18565/urology.2022.2.136-139

[12] Сазонова Н.А., Киселева М.Г., Гаджиева З.К., Гвоздев М.Ю. Недержание мочи у женщин и его влияние на качество жизни // Урология. 2022. № 2. С. 136–139.

[13] Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn. 2008;27(8):749–757. DOI: 10.1002/nau.20635

[14] Hunskaar S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women // Neurourol Urodyn. 2008. Vol. 27, No. 8. P. 749–757. DOI: 10.1002/nau.20635

[15] Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study. BJOG. 2003;110(3):247–254.

[16] Hannestad Y.S., Rortveit G., Daltveit A.K., Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study // BJOG. 2003. Vol. 110, No. 3. P. 247–254.

[17] Legendre G, Fritel X, Capmas P, et al. Urinary incontinence and obesity. J Gynecol Obstet Biol Reprod (Paris). 2012;41(4):318–323 (In French). DOI: 10.1016/j.jgyn.2012.02.007

[18] Legendre G., Fritel X., Capmas P., et al. Incontinence urinaire et obésité // J Gynecol Obstet Biol Reprod (Paris). 2012. Vol. 41, No. 4. P. 318–323. DOI: 10.1016/j.jgyn.2012.02.007

[19] Townsend MK, Danforth KN, Rosner B, et al. Body mass index, weight gain, and incident urinary incontinence in middle-aged women. Obstet Gynecol. 2007;110(2 Pt 1):346–353. DOI: 10.1097/01.AOG.0000270121.15510.57

[20] Townsend M.K., Danforth K.N., Rosner B., et al. Body mass index, weight gain, and incident urinary incontinence in middle-aged women // Obstet Gynecol. 2007. Vol. 110, No. 2 Pt 1. P. 346–353. DOI: 10.1097/01.AOG.0000270121.15510.57

[21] Cummings JM, Rodning CB. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11(1):41–44. DOI: 10.1007/s001920050008.

[22] Cummings J.M., Rodning C.B. Urinary stress incontinence among obese women: review of pathophysiology therapy // Int Urogynecol J Pelvic Floor Dysfunct. 2000. Vol. 11, No. 1. P. 41–44. DOI: 10.1007/s001920050008

[23] Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg. 2005;15(9):1225–1232. DOI: 10.1381/096089205774512546

[24] Lambert D.M., Marceau S., Forse R.A. Intra-abdominal pressure in the morbidly obese // Obes Surg. 2005. Vol. 15, No. 9. P. 1225–1232. DOI: 10.1381/096089205774512546

[25] Ramalingam K, Monga A. Obesity and pelvic floor dysfunction. Best Pract Res Clin Obstet Gynaecol. 2015;29(4):541–547. DOI: 10.1016/j.bpobgyn.2015.02.002

[26] Ramalingam K., Monga A. Obesity and pelvic floor dysfunction // Best Pract Res Clin Obstet Gynaecol. 2015. Vol. 29, No. 4. P. 541–547. DOI: 10.1016/j.bpobgyn.2015.02.002

[27] Manna P, Jain SK. Obesity, oxidative stress, adipose tissue dysfunction, and the associated health risks: causes and therapeutic strategies. Metab Syndr Relat Disord. 2015;13(10):423–444. DOI: 10.1089/met.2015.0095

[28] Manna P., Jain S.K. Obesity, oxidative stress, adipose tissue dysfunction, and the associated health risks: causes and therapeutic strategies // Metab Syndr Relat Disord. 2015. Vol. 13, No. 10. P. 423–444. DOI: 10.1089/met.2015.0095

[29] Liu C, Yang Q, Fang G, et al. Collagen metabolic disorder induced by oxidative stress in human uterosacral ligament-derived fibroblasts: A possible pathophysiological mechanism in pelvic organ prolapse. Mol Med Rep. 2016;13(4):2999–3008. DOI: 10.3892/mmr.2016.4919

[30] Liu C., Yang Q., Fang G., et al. Collagen metabolic disorder induced by oxidative stress in human uterosacral ligament-derived fibroblasts: A possible pathophysiological mechanism in pelvic organ prolapse // Mol Med Rep. 2016. Vol. 13, No. 4. P. 2999–3008. DOI: 10.3892/mmr.2016.4919

[31] Gorbachinsky I, Akpinar H, Assimos DG. Metabolic syndrome and urologic diseases. Rev Urol. 2010;12(4):157–180.

[32] Gorbachinsky I., Akpinar H., Assimos D.G. Metabolic syndrome and urologic diseases // Rev Urol. 2010. Vol. 12, No. 4. P. 157–180.

[33] Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481–490. DOI: 10.1056/NEJMoa0806375

[34] Subak L.L., Wing R., West D.S., et al. Weight loss to treat urinary incontinence in overweight and obese women // N Engl J Med. 2009. Vol. 360, No. 5. P. 481–490. DOI: 10.1056/NEJMoa0806375

[35] Imamura M, Williams K, Wells M, McGrother C. Lifestyle interventions for the treatment of urinary incontinence in adults. Cochrane Database Syst Rev. 2015(12):CD003505. DOI: 10.1002/14651858.CD003505.pub5

[36] Imamura M., Williams K., Wells M., McGrother C. Lifestyle interventions for the treatment of urinary incontinence in adults // Cochrane Database Syst Rev. 2015, No. 12. P. CD003505. DOI: 10.1002/14651858.CD003505.pub5

[37] Fuselier A, Hanberry J, Margaret Lovin J, Gomelsky A. Obesity and stress urinary incontinence: impact on pathophysiology and treatment. Curr Urol Rep. 2018;19(1):10. DOI: 10.1007/s11934-018-0762-7

[38] Fuselier A., Hanberry J., Margaret Lovin J., Gomelsky A. Obesity and stress urinary incontinence: impact on pathophysiology and treatment // Curr Urol Rep. 2018. Vol. 19, No. 1. P. 10. DOI: 10.1007/s11934-018-0762-7

[39] Chung MK, Chung RP. Comparison of laparoscopic Burch and tension-free vaginal tape in treating stress urinary incontinence in obese patients. JSLS. 2002;6(1):17–21.

[40] Chung M.K., Chung R.P. Comparison of laparoscopic Burch and tension-free vaginal tape in treating stress urinary incontinence in obese patients // JSLS. 2002. Vol. 6, No. 1. P. 17–21.

[41] Kirchin V, Page T, Keegan PE, et al. Urethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev. 2012;(2): CD003881. DOI: 10.1002/14651858.CD003881.pub3

[42] Kirchin V., Page T., Keegan P.E., et al. Urethral injection therapy for urinary incontinence in women // Cochrane Database Syst Rev. 2012. No. 2. P. CD003881. DOI: 10.1002/14651858.CD003881.pub3

[43] Klinicheskie rekomendatsii: Nederzhanie mochi. Moscow: Izdatel’stvo Pero; 2021. 60 p. (In Russ.)

[44] Клинические рекомендации: Недержание мочи. Москва: Перо, 2021. 60 с.

[45] Hellberg D, Holmgren C, Lanner L, Nilsson S. The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(4):423–429. DOI: 10.1007/s00192-006-0162-2

[46] Hellberg D., Holmgren C., Lanner L., Nilsson S. The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence // Int Urogynecol J Pelvic Floor Dysfunct. 2007. Vol. 18, No. 4. P. 423–429. DOI: 10.1007/s00192-006-0162-2

[47] Killingsworth LB, Wheeler TL, Burgio KL, et al. One-year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1103–1108. DOI: 10.1007/s00192-009-0909-7

[48] Killingsworth L.B., Wheeler T.L., Burgio K.L., et al. One-year outcomes of tension-free vaginal tape (TVT) mid-urethral slings in overweight and obese women // Int Urogynecol J Pelvic Floor Dysfunct. 2009. Vol. 20, No. 9. P. 1103–1108. DOI: 10.1007/s00192-009-0909-7

[49] Oliveira R, Botelho F, Silva P, et al. Single-incision sling system as primary treatment of female stress urinary incontinence: prospective 12 months data from a single institution. BJU Int. 2011;108(10):1616–1621. DOI: 10.1111/j.1464-410X.2011.10158.x

[50] Oliveira R., Botelho F., Silva P., et al. Single-incision sling system as primary treatment of female stress urinary incontinence: prospective 12 months data from a single institution // BJU Int. 2011. Vol. 108, No. 10. P. 1616–1621. DOI: 10.1111/j.1464-410X.2011.10158.x

[51] Weltz V, Guldberg R, Lose G. Efficacy and perioperative safety of synthetic mid-urethral slings in obese women with stress urinary incontinence. Int Urogynecol J. 2015;26(5):641–648. DOI: 10.1007/s00192-014-2567-7

[52] Weltz V., Guldberg R., Lose G. Efficacy and perioperative safety of synthetic mid-urethral slings in obese women with stress urinary incontinence // Int Urogynecol J. 2015. Vol. 26, No. 5. P. 641–648. DOI: 10.1007/s00192-014-2567-7

[53] Lo TS, Al-Kharabsheh AM, Pue LB, et al. Mid urethral slings for the treatment of urodynamic stress incontinence in overweight and obese women: surgical outcomes and preoperative predictors of failure. J Urol. 2020;204(4):787–792. DOI: 10.1097/JU.0000000000001085

[54] Lo T.S., Al-Kharabsheh A.M., Pue L.B., et al. Mid urethral slings for the treatment of urodynamic stress incontinence in overweight and obese women: surgical outcomes and preoperative predictors of failure // J Urol. 2020. Vol. 204, No. 4. P. 787–792. DOI: 10.1097/JU.0000000000001085

[55] Meschia M, Rossi G, Bertini S, et al. Single incision mid-urethral slings: impact of obesity on outcomes. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):571–574. DOI: 10.1016/j.ejogrb.2013.08.007

[56] Meschia M., Rossi G., Bertini S., et al. Single incision mid-urethral slings: impact of obesity on outcomes // Eur J Obstet Gynecol Reprod Biol. 2013. Vol. 170, No. 2. P. 571–574. DOI: 10.1016/j.ejogrb.2013.08.007

[57] Barco-Castillo C, Plata M, Zuluaga L, et al. Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis. Neurourol Urodyn. 2020;39(8):2153–2160. DOI: 10.1002/nau.24459

[58] Barco-Castillo C., Plata M., Zuluaga L., et al. Obesity as a risk factor for poor outcomes after sling surgery in women with stress urinary incontinence: A systematic review and meta-analysis // Neurourol Urodyn. 2020. Vol. 39, No. 8. P. 2153–2160. DOI: 10.1002/nau.24459

[59] Elshatanoufy S, Matthews A, Yousif M, et al. Effect of morbid obesity on midurethral sling efficacy for the management of stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2019;25(6):448–452. DOI: 10.1097/SPV.0000000000000594

[60] Elshatanoufy S., Matthews A., Yousif M., et al. Effect of morbid obesity on midurethral sling efficacy for the management of stress urinary incontinence // Female Pelvic Med Reconstr Surg. 2019. Vol. 25, No. 6. P. 448–452. DOI: 10.1097/SPV.0000000000000594

[61] Kim A, Kim MS, Park YJ, et al. Retropubic versus transobturator mid urethral slings in patients at high risk for recurrent stress incontinence: a systematic review and meta-analysis. J Urol. 2019;202(1):132–142. DOI: 10.1097/JU.0000000000000222

[62] Kim A., Kim M.S., Park Y.J., et al. Retropubic versus transobturator mid urethral slings in patients at high risk for recurrent stress incontinence: A systematic review and meta-analysis // J Urol. 2019. Vol. 202, No. 1. P. 132–142. DOI: 10.1097/JU.0000000000000222

[63] Piskunova EV. Lechenie nederzhaniya mochi u bol’nykh s ozhireniem [dissertation]. Moscow; 2006. 133 p. Available from: https://www.dissercat.com/content/lechenie-nederzhaniya-mochi-u-bolnykh-s-ozhireniem. Accessed: 2023 July 07 (In Russ.)

[64] Пискунова Е.В. Лечение недержания мочи у больных с ожирением: дис. … канд. мед. наук. Москва, 2006. 133 c. Режим доступа: https://www.dissercat.com/content/lechenie-nederzhaniya-mochi-u-bolnykh-s-ozhireniem. Дата обращения: 20.07.2023.

[65] Lau HH, Enkhtaivan S, Su TH, Huang WC. The outcome of a single-incision sling versus trans-obturator sling in overweight and obese women with stress urinary incontinence at 3-year follow-up. J Clin Med. 2019;8(8):1099. DOI: 10.3390/jcm8081099

[66] Lau H.H., Enkhtaivan S., Su T.H., Huang W.C. The outcome of a single-incision sling versus trans-obturator sling in overweight and obese women with stress urinary incontinence at 3-year follow-up // J Clin Med. 2019. Vol. 8, No. 8. P. 1099. DOI: 10.3390/jcm8081099

[67] Schiavi MC, Carletti V, Yacoub V, et al. Evaluation of the efficacy and safety of single incision sling vs TVT-O in obese patients with stress urinary incontinence: Quality of life and sexual function analysis. Taiwan J Obstet Gynecol. 2023;62(1):89–93. DOI: 10.1016/j.tjog.2022.07.011

[68] Schiavi M.C., Carletti V., Yacoub V., et al. Evaluation of the efficacy and safety of single incision sling vs TVT-O in obese patients with stress urinary incontinence: Quality of life and sexual function analysis // Taiwan J Obstet Gynecol. 2023. Vol. 62, No. 1. P. 89–93. DOI: 10.1016/j.tjog.2022.07.011

[69] Schütze S, Behre J, Heitmeir B, et al. The transobturator tape versus retropubic tension-free vaginal tape in the treatment of comorbid and elderly women with stress urinary incontinence: a retrospective analysis of over 800 women. Cureus. 2023;15(1):e34072. DOI: 10.7759/cureus.34072

[70] Schütze S., Behre J., Heitmeir B., et al. The transobturator tape versus retropubic tension-free vaginal tape in the treatment of comorbid and elderly women with stress urinary incontinence: A retrospective analysis of over 800 women // Cureus. 2023. Vol. 15, No. 1. P. e34072. DOI: 10.7759/cureus.34072

[71] Urinary incontinence and pelvic organ prolapse in women: management. London: National Institute for Health and Care Excellence (NICE); 2019 Jun. PMID: 31211537.

[72] O’Boyle CJ, O’Sullivan OE, Shabana H, et al. The effect of bariatric surgery on urinary incontinence in women. Obes Surg. 2016;26(7):1471–1478. DOI: 10.1007/s11695-015-1969-z

[73] O’Boyle C.J., O’Sullivan O.E., Shabana H., et al. The effect of bariatric surgery on urinary incontinence in women // Obes Surg. 2016. Vol. 26, No. 7. P. 1471–1478. DOI: 10.1007/s11695-015-1969-z

[74] Sheridan W, Da Silva AS, Leca BM, et al. Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis. Clin Obes. 2021;11(4):e12450. DOI: 10.1111/cob.12450

[75] Sheridan W., Da Silva A.S., Leca B.M., et al. Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis // Clin Obes. 2021. Vol. 11, No. 4. P. e12450. DOI: 10.1111/cob.12450

[76] Rodrigues AFS, Korkes F, Bezerra DSD, et al. Impact of bariatric surgery in patients with stress urinary incontinence. Einstein (Sao Paulo). 2021;19: eAO5701. DOI: 10.31744/einstein_journal/2021AO5701

[77] Rodrigues A.F.S., Korkes F., Bezerra D.S.D., et al. Impact of bariatric surgery in patients with stress urinary incontinence // Einstein (Sao Paulo). 2021. Vol. 19. P. eAO5701. DOI: 10.31744/einstein_journal/2021AO5701

[78] Anglim B, O’Boyle CJ, O’Sullivan OE, O’Reilly BA. The long-term effects of bariatric surgery on female urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2018;231:15–18. DOI: 10.1016/j.ejogrb.2018.10.011

[79] Anglim B., O’Boyle C.J., O’Sullivan O.E., O’Reilly B.A. The long-term effects of bariatric surgery on female urinary incontinence // Eur J Obstet Gynecol Reprod Biol. 2018. Vol. 231. P. 15–18. DOI: 10.1016/j.ejogrb.2018.10.011

Funding

Работа профинансирована в рамках государственного задания Научно-исследовательского института клинической и экспериментальной лимфологии — филиала ФГБНУ «Федеральный исследовательский центр Институт цитологии и генетики» СО РАНWork funded within the framework of the state assignment of the Scientific Research Institute of Clinical and Experimental Lymphology — Branch of the Federal State Budgetary Institution “Federal Research Center Institute of Cytology and Genetics” of the Siberian Branch of the Russian Academy of Sciences

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