Objective: To examine epidemiologic, anthropometric and clinical variables associated with stress urinary incontinence in obese women, before and after bariatric surgery, and to identify predictive factors of stress urinary incontinence resolution. Methods: Prospective observational study with women enrolled in a bariatric surgery program between 2015 and 2016. Patients were assessed prior to and 6 months after bariatric surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale. Patient assessment also included physical examination and bladder stress tests. Results: A total of 43 women completed the study. There was a 72.7% reduction in stress urinary incontinence (p=0.021). Predictive factors for preoperative diagnosis of stress urinary incontinence included age (p=0.024) and abdominal waist circumference (p=0.048). Urinary symptoms improved after weight loss, especially nocturia (p=0.001) and stress urinary incontinence (p=0.026). Menopause was the most significant predictive factor for persistence of stress urinary incontinence within six months of bariatric surgery (p=0.046). Self-reported outcomes and scores obtained in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale were associated with significant improvement (p=0.012, p=0.025, and p=0.002 respectively). Conclusion: Older women with larger waist circumference have a higher risk of developing stress urinary incontinence prior to bariatric surgery. Menopausal women are highly prone to persistent stress urinary incontinence, even after weight loss. Weight loss achieved through bariatric surgery improved stress urinary incontinence symptoms and mitigated related impacts on quality of life in the vast majority of women.

Aims To compare 300 U versus 500 U of abobotulinumtoxinA (ABO) intravesical injections for the treatment of idiopathic overactive bladder (OAB) refractory to first and second‐line treatments. Methods A prospective, randomized, single blind study was performed in female patients with symptoms of OAB, who had failed conservative treatment. Patients were treated with 300 or 500 U of ABO injected into 30 sites, avoiding the trigone. All treatments were evaluated by voiding diary, ICIQ‐OAB questionnaire, urodynamic test, visual analogue scale (VAS) for treatment satisfaction and patient global impression of improvement (PGI‐I). The primary outcome was change in maximum cistometric capacity (MCC). Secondary outcome included changes in urgency, complete continence, subjective success (VAS and PGI‐I), and adverse events (urinary retention, UTI, and CIC). Results Twenty‐one patients were included. MCC has increased from 185.0 to 270.9 mL (300 U) and from 240.8 to 311.7 mL (500 U), comparing the baseline with 12 weeks, without statistical difference between the groups (P = 0.270). At 12 weeks, 91% of patients were dry in both groups. At 24 weeks, episodes of incontinence had returned in 50% (300 U) and 0% (500 U) (P = 0.013). Patients were better or much better (PGI‐I) in70% (300 U) and 88.9% (500 U) at 12 w; and 50% (300 U) and 100% (500 U), at 24 w (P = 0.027). The peak of PVR was at 4 w, being 71.7 mL (300 U) and 96.5 mL (500 U). General UTI incidence was 35.7%. One patient (500 U) required CIC for 2 weeks. Conclusions Intravesical ABO injection at 500 U improves symptoms and quality of life for longer period of time than 300 U for idiopathic OAB.

Assessment (GRA), Interstitial Cystitis Symptom/Problem Index (ICSIPI) and Overactive Bladder symptom severity (OABq ss)/health related quality of life (HRQOL) collected at baseline, 3 and 6 months, and 1 and 2 years were analyzed with descriptive statistics and repeated measures over 1 year.RESULTS: Of 87 that had a lead placed, 72 (83%) had generator implantation and 65 had complete baseline data. 37/65 had a pudendal (12/37 had failed sacral stimulation) and 28 had a sacral lead. Group characteristics were similar except for pudendal had lower body mass index (median 24.8 vs. 28.6; p¼0.009) and fewer with primary urinary urgency/frequency (8.1% vs. 39.3%; p¼0.003). Pudendal patients more commonly had a primary diagnosis of pelvic pain that approached but was not statistically significantly (62.2% vs. 38.5%; p¼0.06). Median follow up was 1.2 vs. 2.6 years in the pudendal and sacral groups respectively (p¼0.0011). Median pelvic pain scores were similar between pudendal and sacral groups at baseline and each follow up, and both improved significantly over 1 year (p¼0.0003 and p<0.0001). The pudendal group had lower ISCIPI and OABq/ss scores at baseline (p¼0.007 and p¼0.035, respectively), but both groups improved over 1 year on the ICSIPI (p<0.0001 for both groups), OABq/ ss (p¼0.005 and p¼0.0002 respectively), and OABq HRQOL (p¼0.027 and p<0.0001, respectively). Similar proportions in the pudendal and sacral groups had pain at each follow up except for at 6 months (17/19; 90% vs. 8/14; 57%; p¼0.047); for those with pain, similar proportions (between 33% and 50%) had moderate/marked improved in pain on the GRA at each time point.CONCLUSIONS: Both groups experienced modest but similar improvements in pelvic pain. Pudendal was effective in those who failed sacral neuromodulation and was used preferentially in patients with a primary diagnosis of pain. Neuromodulation should be considered in the management of chronic pelvic pain.