Metabolic Bariatric Surgery Improves Pelvic Floor and Voiding Function in Asian Women with Obesity: A Prospective Cohort Study

Metabolic bariatric surgery (MBS) provides durable weight loss and metabolic improvement in individuals with obesity. However, its impact on pelvic floor and voiding dysfunction, common but under-recognized obesity-related conditions, remains poorly characterized, particularly in Asian women. To evaluate changes in pelvic floor dysfunction and voiding function following MBS in Asian women with obesity using validated symptom scores and objective uroflowmetry. This prospective cohort study included 87 women undergoing MBS at a tertiary center in Southeast Asia. Pelvic floor symptoms were assessed preoperatively and at six months postoperatively using the Pelvic Floor Distress Inventory (PFDI-20). Objective voiding function was evaluated with uroflowmetry, including flow pattern and post-void residual (PVR) volume. Paired comparisons were performed using Wilcoxon Signed Rank and McNemar’s tests. Logistic regression was used to identify predictors of clinically meaningful improvement (≥ 13.5-point reduction in PFDI-20 score). Median body mass index decreased significantly from 41.0 to 33.0 kg/m² at 6 months (p < 0.001). Significant improvements were observed in total PFDI-20 scores and all subdomains (POPDI-6, CRADI-8, and UDI-6; all p < 0.001). Median PVR volume decreased from 22 mL to 0 mL (p = 0.004), and the proportion of normal (bell-shaped) uroflowmetry patterns increased from 52.2% to 81.6% (p = 0.004). Overall, 55.2% of patients achieved clinically meaningful symptom improvement. In multivariable analysis, marital status independently predicted improvement (adjusted odds ratio 0.11; p = 0.039). Metabolic bariatric surgery was associated with significant improvements in pelvic floor symptoms and objective voiding function in Asian women with obesity. These findings highlight an expanded spectrum of functional benefits beyond metabolic disease control and suggest that pelvic floor health should be considered an important component of perioperative assessment and outcome evaluation in women undergoing metabolic and bariatric surgery.