Impact of Surgical Weight Loss Interventions on Urinary Incontinence in Obese Women: Systematic Review and Meta-Analysis.

INTRODUCTION AND HYPOTHESIS: Obesity is strongly associated with urinary incontinence (UI) in women, contributing to significant physical and psychological morbidity. Surgical weight loss interventions such as bariatric surgery are increasingly utilised to manage obesity and may offer therapeutic benefits for UI. This systematic review and meta-analysis aimed to evaluate the impact of bariatric surgery on urinary incontinence outcomes and related pelvic floor symptoms in obese women. METHODS: Following PRISMA and Cochrane guidelines, a comprehensive literature search was performed across multiple databases (1998-2025). Eligible studies included obese adult women (BMI ≥30 kg/m2) undergoing bariatric surgery with reported urinary incontinence. Primary outcomes were subjective and objective measures of UI improvement; secondary outcomes included changes in body mass index (BMI), quality of life (QoL), sexual function, anal incontinence (AI), and pelvic organ prolapse (POP). RESULTS: Thirty-nine studies encompassing 8960 women were included. Meta-analysis showed a significant improvement in UI incidence at 6, 12, and >12 months post-surgery. Pooled analysis from patient reported measures yielded RR 2.08, 95% CI 1.80-2.40, p = 0.00001, and objectively measured MD 3.62, 95% CI 2.57-4.67, all p = 0.00001. Mean BMI decreased significantly (MD 12.75, 95% CI 11.34-14.16, p = 0.00001) and QoL scores improved substantially (SMD 2.96, 95% CI 0.42-5.49, p = 0.001). CONCLUSION: Bariatric surgery is a highly effective intervention for improving urinary incontinence and related quality of life in obese women, with sustained benefits corresponding to significant reductions in BMI. Further long-term, standardised prospective studies are warranted to clarify the broader pelvic floor effects of surgical weight loss.