Bariatric Surgery for Urinary problems
16 November 2018
Urinary symptoms such as Stress incontinence, urinary frequecy, getting up in the night to pass urine multiple times and even recurrent Urinary Tract Infections are not symptoms that we frequently talk about with our GP. This may be because it is embarrassing or we might think what we are experiencing is normal or that there probably isn't a solution to the issue. Because it is not widely discussed the size of the problem is not well known either. It seems, however, that these symptoms are at least partly reversible for lots of people who have had Bariatric surgery. The actual mechanism by which the improvement occurs is unknown but it does mimic some of the other post-bariatric improvements in co-morbidities such as diabetes and blood pressure etc. This is great news for people who struggle with urinary symptoms, as a solution may be available!
Bariatric surgery may reduce the frequency and severity of lower urinary tract symptoms, according to the findings from two studies published in BJU International. The studies from researchers in France and researchers in New Zealand, indicate that urinary problems may be added to the list of issues that can improve with efforts that address altered metabolism.
Lower urinary tract symptoms related to urinary frequency and urgency, bladder leakage, the need to urinate at night, and incomplete bladder emptying are associated with obesity in both men and women. To see if these symptoms might also be linked with metabolic syndrome (a cluster of abnormalities including hypertension, high cholesterol, high blood glucose levels, and abdominal obesity), Dr François Desgrandchamps from Saint-Louis Hospital in France, and his colleagues analysed information on 4,666 male patients aged 55 to 100 years who consulted a general practitioner during a 12-day period in 2009.
Metabolic syndrome was reported in 51.5% of the patients and 47% were treated for LUTS. There was a significant link between metabolic syndrome and treated LUTS (p<0.001). The risk of being treated for LUTS also increased with an increasing number of metabolic syndrome components present. Metabolic syndrome was positively correlated with the severity of the LUTS (p<0.001) for overall IPSS and both voiding and storage scores (p<0.001). Each component of the metabolic syndrome (except high-density lipoprotein-cholesterol) appeared as an independent risk factor of high IPSS and of LUTS treatment in multivariate analysis. Metabolic syndrome was positively correlated with prostate volume.
“Our results suggest a significant relationship between LUTS linked to benign prostatic hyperplasia and metabolic syndrome, in terms of frequency and severity. The risk of being treated for LUTS also increased with an increasing number of metabolic syndrome components present. The prevention of such modifiable factors by the promotion of dietary changes and regular physical activity practice may be of great importance for public health," the authors concluded.
In the second study, the researchers looked to see if weight loss or bariatric surgery in obese individuals might lessen LUTS in a prospective cohort study.
Patients undergoing bariatric surgery were recruited into the study. LUTS were assessed using the International Prostate Symptoms Score (IPSS) in men and Bristol Female Lower Urinary Tract Symptoms Score Questionnaire (BFLUTS) in women. Serum glucose, insulin and prostate-specific antigen (PSA) levels were recorded; insulin resistance was quantified using the Homeostasis Model Assessment (HOMA-IR) method. Patients were assessed before surgery, and at 6–8 weeks and one year after surgery. Weight loss, change in BMI, total symptoms score as well as individual symptoms were tested for statistical significance with correction for multiple testing using Bonferroni method.
Linear regression analysis was performed with total symptoms score change at one year as the outcome variable and BMI, age, total symptoms score before surgery, HOMA-IR, glucose level before surgery, insulin level before surgery, change in insulin level after surgery, weight loss and BMI loss as predictor variables.
They report that in total 86 patients were recruited and 82% completed at least one follow-up after surgery (n=72). There was significant weight loss and reduction of BMI after surgery (p<0.001). At six weeks, there was a significant reduction in overall symptom score (p<0.001) and this improvement was sustained at one year. Linear regression analysis showed that total symptoms score at baseline, HOMA-IR, preoperative insulin level and change in insulin level postoperatively were predictive of the change in total symptoms score while the amount of weight loss was not.
The study confirms the improvement in LUTS after weight loss but there is no correlation between the improvement and the time course or degree of weight loss. Rather there is a suggestion that the improvement in symptoms is linked to improvement in insulin resistance seen as a result of both bariatric surgery and weight loss.
"Interestingly, in our study, improvements in lower urinary tract symptoms were generally seen soon after surgery, and they did not seem to be related to the time course or degree of weight loss," said co-author Dr Richard Stubbs from Wakefield Hospital, Wellington. "Rather, there is an indication that the improvement in the urinary symptoms is linked to improvements in insulin resistance, which are now known to occur almost immediately following bariatric surgery."
The investigators noted that it is not a surprise that many symptoms and medical problems associated with obesity improve when weight loss occurs.
"What has been a surprise and what is potentially so important is that so many problems, including issues related to urinary function, improve so quickly after bariatric surgery, even before great weight loss has occurred," said senior author Andrew Kennedy-Smith also from Wellington Hospital. "The relationship we have found between these symptoms and insulin resistance is of considerable potential importance. This finding calls into question our fundamental understanding of why these problems arise, and therefore how they might best be treated."
Traditional thinking suggests that obesity leads to insulin resistance, but perhaps insulin resistance is itself a major cause of obesity. Therefore, developing effective treatments for insulin resistance may help address a whole raft of conditions, including lower urinary tract symptoms.
Check out this link from NZHerald!
18 April 2018
I thought you might like this story. I concur with all the things Rob Cable says in this article - all the same things I hear from my patients... He was the first Bariatric Surgeon I worked with very early in my training. Still going strong and a lovely Guy too.
StephRead more here
Bariatric surgery changes patients' perception of food
16 February 2018
The evidence quoted in the studies below is consistent with what I tell my patients - I might be doing something physical during the operation ie removing about 80% of the stomach with Gastric Sleeve surgery for example, but the brain plays just as big a part in the final outcome of the surgery. How the brain reacts to what is happening to the body is the big unknown, however, this evidence suggests that there is a measurable difference in how the brain is behaving followimg weight loss surgery. For this reason it is essential to work with both the body and the brain in order to get the optimal result. My definition of optimal result is long term weight loss - the holy grail of any weight loss treatment. It is essentiwl that both the body and brain are working in harmony to achieve an excellent outcome. For some this is dealing with emotional or binge eating tendencies and for others it is changing perceptions of themselves and their bodies to get maximum benefit from the opportunities that significant weight loss can give you. Anyway, food for thought and something I would love to talk with you further about if this rings bells with you. Look forward to meeting you at BetterLife Surgery soon!
Not only does bariatric surgery help people lose weight may work by reducing the amount they eat, it can also change what they want to eat improving glycaemic control after surgery, according to research in Diabetes Care, the journal of the American Diabetes Association (ADA).
In the study, ‘Neuronal Food Reward Activity in Patients With Type 2 Diabetes With Improved Glycemic Control After Bariatric Surgery’, the researchers, led by Sabine Frank of the University of Tubingen in Germany, sought to identify how the neuronal and behavioural reward centres in the brain, correlates with improved glycaemic control after bariatric surgery.
They established two patient groups with T2DM:tThe treatment group (n=12) consisted of patients who had undergone Roux-en-Y gastric bypass (RYGB) surgery, and a control group consisted of patients who did not undergo surgery (n=12). The groups were matched for age and current BMI. HbA1c was matched by using the presurgical HbA1c of the RYGB group and the current HbA1c of the nonsurgical group. Neuronal activation during a food reward task was measured using functional MRI (fMRI) and behavioural data were assessed through questionnaires.
They reported that in the first group, RYGB improved HbA1c from 7.07±0.50 to 5.70±0 (16%, p<0.05) and BMI from 52.21±1.90 to 35.71±0.84 (p<0.001). Behavioural results showed lower wanting and liking scores as well as lower eating behaviour-related pathologies for the patients after RYGB than for similar obese subjects without surgery but with impaired glycaemic control.
The fMRI analysis showed higher activation for the non-surgical group in areas associated with inhibition and reward as well as in the precuneus, a major connectivity hub in the brain. By contrast, patients after RYGB showed higher activation in the visual, motor, cognitive control, memory, and gustatory regions.
The study is consistent with recent results from a study from the University of Texas Southwestern Medical Center, who reported in the journal Obesity, that brain scans showed severely obese women had very different responses to food than others that their reward centres, in effect, kept telling them to eat even after they were no longer hungry.
“In obese patients with diabetes, RYGB normalises glycaemic control and leads to food reward-related brain activation patterns that are different from those of obese patients with less-well-controlled T2DM and without bariatric surgery,” the authors concluded. “The differences in food reward processing might be one factor in determining the outcome of bariatric surgery in patients with T2DM.”
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