Effects of Bariatric Surgery on Lower Urinary Tract Symptoms in Men

1. No. 110 Effects of Bariatric Surgery on Lower Urinary Tract Symptoms in Men S. Luke*, J. Masters*, R. Stubbs†, A. Kennedy-Smith† *Auckland City Hospital, Auckland, New Zealand, †Wakefield Hospital, Wellington, New Zealand Results 29 patients were recruited, 4 of them withdrew for various reasons. Six weeks follow-up is complete for 80% and 1 year for 68% of patients. Mean age was 45 (25-60) years. Mean BMI prior to surgery was 47 (35–53); 6 weeks after surgery it was 41 (32-51); 1 year after surgery it was 34 (27-41). Mean IPSS improved from 5.76 (1-22) before surgery to 3.26 six weeks following surgery (p<0.001, 95% CI 1.41-5.09) and 3.46 one year after surgery (p=0.005, 95% CI 1.8-5.12). Improvement in symptoms was observed in 73% of patients; 9% reported some deterioration. Improvement was noted to be more significant in storage symptoms (mean improvement 1.73 at 6 weeks and 1.76 at 1 year) then in voiding symptoms (mean improvement 0.80 at 6 weeks and 0.62 at 1 year). Symptomatic improvement was most significant in patients with moderate to severe LUTS preoperatively (IPSS > 7) with mean improvement of 5.5 at 6 weeks and 8.2 at 1 year. Introduction Obesity is associated with increased prevalence of LUTS. The mechanism by which obesity affects bladder function is uncertain, although LUTS have been linked to metabolic syndrome, which in turn is associated with obesity [1]. Metabolic syndrome and insulin resistance resolve promptly following bariatric surgery [2]. We postulated that bariatric surgery may significantly influence LUTS in morbidly obese patients, independently of weight loss. Aim To quantify changes in prevalence and severity of Lower Urinary Tract Symptoms in patients with morbid obesity undergoing gastric bypass surgery. • Methods • This prospective cohort study was approved by the New Zealand Northern Regional Ethics Committee and recruited patients undergoing bariatric surgery (open and laparoscopic gastric bypass or laparoscopic sleeve gastrectomy) in 3 centres in New Zealand. • Inclusion Criteria • BMI > 35 • Age > 18 • Exclusion Criteria • History of urological problem other then BPH or OAB • Use of alpha-blocker or 5-alpha-reductase inhibitor • Renal impairment • Based on our previous retrospective study [3] a sample size was calculated to show change in the baseline IPSS score in 75% of participants. • Assessment was performed some time before surgery, 4-8 weeks after surgery and 1 year after surgery. • Subjective urological assessment used IPSS questionnaire. • Urine flow rate and post void residual volume were measured. • Serum glucose, insulin and PSA were recorded. • Statistical analysis was performed to assess change in the IPSS score before and after surgery using paired t-test. Figure 1. Mean values for individual IPSS items before bariatric surgery and changes postoperatively. Conclusions Obese patients with LUTS, particularly those reporting moderate and severe bother, experience significant and sustained improvement in symptoms following bariatric surgery. This effect appears early and independent of weight loss suggesting an associated metabolic pathway is responsible for these changes. References Rohrmann S et al. Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III). Int J Obes (Lond). 2005 Mar: 29:310-6 WickremesekeraK et al. Loss of insulin resistance after Roux-en-Y gastric bypass surgery: a time course study. Obes Surg. 2005 Apr: 15:474-81 Luke S et al. LUTS in Men Undergoing Gastric Bypass Surgery. BJUI. 2009 Mar Suppl: 103:2 Acknowledgements This study was sponsored by research grants from Johnson & Johnson and Goodfellow Urology Research Fund. Poster presentation sponsor