The Impact of Bariatric Surgery on Urinary Incontinence: A Systematic Review and Meta-Analysis

Abstract Objectives To systematically review and meta-analyze the impact of bariatric surgery on obese patients with urinary incontinence (UI). Methods A search of Medline, EMBASE, CENTRAL, and PubMed to June 2018 was performed using methods pre-published on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Studies comparing UI status in obese patients before and after bariatric surgery were included. Primary outcomes were the improvement or complete resolution of any UI, stress urinary incontinence (SUI), and urgency urinary incontinence (UUI). Secondary outcomes were validated UI questionnaire scores. The GRADE approach assessed overall quality of evidence. Results 33 cohort studies (2,910 patients) were included (median follow-up 12 months). Bariatric surgery resulted in improvement or resolution of any UI in 56% (95% confidence interval [CI] 48?63%), SUI in 47% (95% CI 34?60%), and UUI in 53% (95% CI 32?73%) of patients. Moreover, bariatric surgery significantly decreased (PPeer reviewe

Canadian Urological Association guideline: Erectile dysfunction.

Erectile dysfunction (ED) impacts the wellness and quality of life of millions of Canadians. An evaluation focused on the identification of reversible and irreversible underlying factors is recommended for patients presenting with ED. Through a shared decision-making model framework, the goal of ED treatment is to improve functional outcomes and enhance sexual satisfaction while minimizing adverse effects associated with treatment. Given that ED is assessed and treated by multiple different types of health practitioners, the purpose of this guideline is to provide the best available evidence to facilitate care delivery through a Canadian lens. After a narrative review of ED assessment and treatment for general readership, five key clinical questions relating to priority areas of ED are assessed using the GRADE and evidence-to-decision-making frameworks