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The effect of bariatric surgery on the improvement of lower urinary tract symptoms in morbidly obese male patients

Prostate Cancer and Prostatic Diseases volume 24, pages 380–388 (2021)Cite this article

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Abstract

Background

Lower urinary tract symptoms (LUTS) are strongly linked with obesity. Whether bariatric surgery can effectively alleviate LUTS in morbidly obese men is unknown. The objective of the present study was to evaluate the effectiveness of bariatric surgery in reducing the prevalence and severity of male LUTS in obese patients.

Methods

This was a prospective observational study on consecutive morbidly obese men undergoing bariatric surgery. The International Prostate Symptom Score (IPSS) was used to assess for LUTS before and at 1–3 years after surgery. The 3-year changes in IPSS, the changes in LUTS severity, and the factors associated with LUTS improvement were evaluated.

Results

This study recruited 143 morbidly obese men (mean age 43.0 ± 10.4 years) undergoing sleeve gastrectomy (n = 89) and Roux-en-Y gastric bypass (n = 54). The rates of follow-up after surgery were 94.4% (n = 119/126) at 1 year, 90.6% (n = 96/106) at 2 years, and 81.2% (n = 69/85) at 3 years. After surgery, there was significant body mass index reduction from 39.1 ± 5.2 kg/m2 preoperatively to 30.1 ± 4.8 kg/m2 at 1 year and 31.5 ± 4.9 kg/m2 at 3 years (P < 0.001). There was significant reduction in IPSS total symptom score, quality of life score, frequency score, and nocturia score (P < 0.05). The prevalence of moderate to severe LUTS reduced from 35.0% (29.4% moderate; 5.6% severe) preoperatively to 21.8% (19.3% moderate; 2.5% severe) at 1 year and 30.4% (24.6% moderate; 5.8% severe) at 3 years (P < 0.001). LUTS improvement was significantly associated with body fat percentage reduction (P = 0.012) and was not associated with weight loss or improvement of metabolic parameters.

Conclusions

Bariatric surgery was an effective and durable intervention for alleviating the prevalence and severity of LUTS in morbidly obese men for up to 3 years.

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Fig. 1: Scatter plots showing the correlation between the percentage reduction of International Prostate Symptom Score (IPSS) total symptom score and anthropometric factors at 1 year.

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References

  1. Giovannucci E, Rimm EB, Chute CG, Kawachi I, Colditz GA, Stampfer MJ, et al. Obesity and benign prostatic hyperplasia. Am J Epidemiol. 1994;140:989–1002.

    Article  CAS  Google Scholar 

  2. Parsons JK, Sarma AV, McVary K, Wei JT. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. J Urol. 2009;182(6 Suppl):S27–S31.

    Article  Google Scholar 

  3. Lee RK, Chung D, Chughtai B, Te AE, Kaplan SA. Central obesity as measured by waist circumference is predictive of severity of lower urinary tract symptoms. BJU Int. 2012;110:540–5.

    Article  Google Scholar 

  4. Kim JH, Sun HY, Park SY, Soh MJ, Kim YJ, Song YS. Association between obesity and lower urinary tract symptoms: propensity score matching study between healthy controls and obese patients seeking bariatric surgery. Surg Obes Relat Dis. 2016;12:1585–93.

    Article  Google Scholar 

  5. Romero-Talamás H, Unger CA, Aminian A, Schauer PR, Barber M, Brethauer S. Comprehensive evaluation of the effect of bariatric surgery on pelvic floor disorders. Surg Obes Relat Dis. 2016;12:138–43.

    Article  Google Scholar 

  6. Cellek S, Cameron NE, Cotter MA, Fry CH, Ilo D. Microvascular dysfunction and efficacy of PDE5 inhibitors in BPH-LUTS. Nat Rev Urol. 2014;11:231–41.

    Article  CAS  Google Scholar 

  7. Boillot A, Zoungas S, Mitchell P, Klein R, Klein B, Ikram MK.META-EYE Study Group et al. Obesity and the microvasculature: a systematic review and meta-analysis. PLoS ONE. 2013;8:e52708.

    Article  CAS  Google Scholar 

  8. Muller RL, Gerber L, Moreira DM, Andriole G Jr, Hamilton RJ, Fleshner N, et al. Obesity is associated with increased prostate growth and attenuated prostate volume reduction by dutasteride. Eur Urol. 2013;63:1115–21.

    Article  CAS  Google Scholar 

  9. Vignozzi L, Gacci M, Cellai I, Santi R, Corona G, Morelli A, et al. Fat boosts, while androgen receptor activation counteracts, BPH-associated prostate inflammation. Prostate. 2013;73:789–800.

    Article  CAS  Google Scholar 

  10. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  Google Scholar 

  11. Montenegro M, Slongo H, Juliato CRT, Minassian VA, Tavakkoli A, Brito LGO. The impact of bariatric surgery on pelvic Floor Dysfunction: a systematic review. J Minim Invasive Gynecol. 2019;26:816–25.

    Article  Google Scholar 

  12. Lee Y, Yu J, Tikkinen KAO, Pedziwiatr M, Major P, Aditya I, et al. The impact of bariatric surgery on urinary incontinence: A systematic review and meta-analysis. BJU Int. 2019;124:917–34.

    Article  Google Scholar 

  13. Uruç F, Akan S, Aras B, Yıldırım Ç, Sahin A, Yuksel OH, et al. Effects of obesity surgery (laparoscopic sleeve gastrectomy technique) on lower urinary tract symptoms, depression and quality of life of males: Prospective study. Arch Ital Urol Androl. 2016;88:258–61.

    Article  Google Scholar 

  14. Ranasinghe WK, Wright T, Attia J, McElduff P, Doyle T, Bartholomew M, et al. Effects of bariatric surgery on urinary and sexual function. BJU Int. 2011;107:88–94.

    Article  Google Scholar 

  15. Luke S, Addison B, Broughton K, Masters J, Stubbs R, Kennedy-Smith A. Effects of bariatric surgery on untreated lower urinary tract symptoms: a prospective multicentre cohort study. BJU Int. 2015;115:466–72.

    Article  CAS  Google Scholar 

  16. Groutz A, Gordon D, Schachter P, Amir H, Shimonov M. Effects of bariatric surgery on male lower urinary tract symptoms and sexual function. Neurourol Urodyn. 2017;36:636–9.

    Article  Google Scholar 

  17. Aleid M, Muneer A, Renshaw S, George J, Jenkinson AD, Adamo M, et al. Early effect of bariatric surgery on urogenital function in morbidly obese men. J Sex Med. 2017;14:205–14.

    Article  Google Scholar 

  18. Fujisaki A, Mizumura Y, Haruyama I, Seki Y, Kasama K, Yoshimura Y. Time-dependent changes in lower urinary tract symptoms in Japanese patients who undergo bariatric and metabolic surgery. Int J Urol. 2019;26:524–6.

    Article  Google Scholar 

  19. Kasama K, Mui W, Lee WJ, Lakdawala M, Naitoh T, Seki Y, et al. IFSO-APC consensus statements 2011. Obes Surg. 2012;22:677–84.

    Article  Google Scholar 

  20. Liu SY, Wong SK, Lam CC, Yung MY, Kong AP, Ng EK. Long-term results on weight loss and diabetes remission after laparoscopic sleeve gastrectomy for a morbidly obese Chinese population. Obes Surg. 2015;25:1901–8.

    Article  CAS  Google Scholar 

  21. Liu SY, Wong SK, Lam CC, Ng EK. Bariatric surgery for Prader-Willi syndrome was ineffective in producing sustainable weight loss: Long term results for up to 10 years. Pediatr Obes. 2020;15:e12575.

    Article  Google Scholar 

  22. Szeto PS. Application of the Chinese version of the International Prostate Symptom Score for the management of lower urinary tract symptoms in a primary health care setting. Hong Kong Med J. 2008;14:458–64.

    CAS  PubMed  Google Scholar 

  23. Choi EP, Lam CL, Chin WY. Validation of the International Prostate Symptom Score in Chinese males and females with lower urinary tract symptoms. Health Qual Life Outcomes. 2014;12:1.

    Article  Google Scholar 

  24. Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992;148:1549–64.

    Article  CAS  Google Scholar 

  25. Richter HE, Creasman JM, Myers DL, Wheeler TL, Burgio KL, Subak LL, et al. Urodynamic characterization of obese women with urinary incontinence undergoing a weight loss program: the Program to Reduce Incontinence by Diet and Exercise (PRIDE) trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1653–8.

    Article  Google Scholar 

  26. Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg. 2005;15:1225–32.

    Article  Google Scholar 

  27. Burgio KL, Richter HE, Clements RH, Redden DT, Goode PS. Changes in urinary and fecal incontinence symptoms with weight loss surgery in morbidly obese women. Obstet Gynecol. 2007;110:1034–40.

    Article  Google Scholar 

  28. Gupta A, Gupta S, Pavuk M, Roehrborn CG. Anthropometric and metabolic factors and risk of benign prostatic hyperplasia: a prospective cohort study of Air Force veterans. Urology. 2006;68:1198–205.

    Article  Google Scholar 

  29. Moran LJ, Brinkworth GD, Martin S, Wycherley TP, Stuckey B, Lutze J, et al. Long-term effects of a randomised controlled trial comparing high protein or high carbohydrate weight loss diets on testosterone, SHBG, erectile and urinary function in overweight and obese men. PLoS ONE. 2016;11:e0161297.

    Article  Google Scholar 

  30. Parsons JK, Carter HB, Partin AW, Windham BG, Metter EJ, Ferrucci L, et al. Metabolic factors associated with benign prostatic hyperplasia. J Clin Endocrinol Metab. 2006;91:2562–8.

    Article  CAS  Google Scholar 

  31. Mills IW, Crossland A, Patel A, Ramonas H. Atorvastatin treatment for men with lower urinary tract symptoms and benign prostatic enlargement. Eur Urol. 2007;52:503–9.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    Shirley Yuk-Wah Liu, Candice Chuen-Hing Lam, Simon Kin-Hung Wong & Enders Kwok-Wai Ng

  2. SH Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    Chi Hang Yee, Peter Ka-Fung Chiu & Chi Fai Ng

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  1. Shirley Yuk-Wah Liu
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Contributions

SYWL was responsible for data collection, data analysis, data interpretation, literature search, and writing of the paper. CHY was responsible for study design, data collection, data analysis, data interpretation, and writing of the paper. PKFC was responsible for data collection, data analysis, data interpretation, and writing of the paper. CCHL was responsible for data collection, data analysis, data interpretation, and generation of figures. SKHW was responsible for study design, data collection, and data interpretation. EKWN was responsible for study design, data collection, and data interpretation. CFN was responsible for study design, data interpretation, literature search and writing of the paper.

Corresponding author

Correspondence to Chi Fai Ng.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the local institutional ethics review board (CREC-2008.497) and was conducted in accordance with the ethical standards of the Helsinki Declaration of 1975 and its later versions.

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Written informed consent was obtained from all patients for study enrollment.

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Liu, S.YW., Yee, C.H., Chiu, P.KF. et al. The effect of bariatric surgery on the improvement of lower urinary tract symptoms in morbidly obese male patients. Prostate Cancer Prostatic Dis 24, 380–388 (2021). https://doi.org/10.1038/s41391-020-00285-1

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