The impact of the mid-urethral slings for the treatment of stress urinary incontinence on female sexuality

Effect of anterior repair on sexual function in heterosexual couples

INTRODUCTION AND HYPOTHESIS

Little is known about the impact of native tissue repair techniques on heterosexual intercourse. This study was aimed at investigating the effect of anterior colporrhaphy on women's and their partners' sexual function.

METHODS

Sexually active women with a male partner who were diagnosed with anterior wall prolapse without any incontinence were prospectively recruited from a single academic center. Demographic data were collected and a Pelvic Organ Prolapse Quantification examination was performed. Before and 3 months post-operatively, women completed two validated questionnaires to assess sexual function, the International Consultation on Incontinence Questionnaire Vaginal Symptoms short form (ICIQ-VS SF) 55, and the Female Sexual Function Index (FSFI), and their male partners completed the International Index of Erectile function-5. Pre- and post-operative results were compared using a paired t test.

RESULTS

This study was conducted in the gynecology department of a university hospital between May 2022 and June 2023, where 50 heterosexual couples were enrolled and underwent isolated anterior repair. The mean age of women and their partners were 44.3 ± 5.12 and 48.1 ± 5.81 respectively. Overall, female sexual function improved significantly from pre- to 3 months postoperatively with a decrease in ICIQ-VS SF scores from 13.3 ± 3.27 to 1.7 ± 1.1 (p < 0.05) and an increase in FSFI scores from 21.74 ± 9.37 to 29.28 ± 9.97 (p < 0.05). The only domain that did not improve was sexual pain. For their male partners, there was a similar significant improvement in sexual function with an increase in scores from 48.71 ± 8.71 to 60.68 ± 8.63 (p < 0.05).

CONCLUSIONS

Isolated anterior repair was associated with improved short-term sexual function amongst heterosexual couples.

Sexual Function Before and After Mid-Urethral Sling Procedure for Stress Urinary Incontinence

Purpose

We aimed to assess the effect of TOT procedure on sexual function and quality of life in sexually active patients.

Materials and Methods

Forty-one patients with SUI aged 18-70 years participated in this study during 2015-2019. Sexual function was evaluated by Female Sexual Function Index (FSFI), Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory Questionnaire (UDI-6) prior to TOT surgery and six months after surgery.

Results

The mean IIQ-7 and UDI-6 scores were significant lower after surgery (P < 0.001). The mean FSFI score was 22.69 ± 5.48 prior to surgery and 29.79 ± 4.12 in the sixth month after surgery (P < 0.001). We found significant changes in all FSFI domains except for pain. Two patients complained of new dyspareunia after surgery. There was also a direct significant correlation between education and sexual function improvement in terms of desire (P = 0.031).

Conclusion

TOT can significantly enhance sexual function with low rate of complications in patients with SUI.

Impact of Autologous Transobturator Sling Surgery on Female Sexual Function: A Comparative Study with Mesh Used Mid-Urethral Sling Surgeries

INTRODUCTION

To avoid mesh-related complications, autologous transobturator-tape (a-TOT) technique is a viable option in stress urinary incontinence (SUI) surgery. The method differs from TOT and retropubic tape (RT) in the usage of autologous tissue. We hypothesized that a-TOT improves female sexual dysfunction (FSD) more than TOT and RT.

METHODS

This is a retrospective cohort study. Patients who underwent a-TOT, TOT, and RT surgeries were surveyed regarding the cure of SUI, complications, and FSD parameters. The groups were compared according to baseline and postoperative data.

RESULTS

A-TOT, TOT, and RT groups included 37, 69, and 36 patients, respectively. The median follow-up time was 19 months. The groups were similar in terms of preoperative characteristics. The objective cure, subjective cure, and overall complication rates were comparable among the groups (p > 0.05). A-TOT group had significant improvements in mean female sexual function index (FSFI) scores, TOT group deteriorated, and RT group remained stable (p = 0.001, p = 0.001, and p = 0.226, respectively). The postoperative mean total FSFI scores were 25.73 ± 2.46, 23.17 ± 3.35, and 21.53 ± 2.47 for the a-TOT, TOT, and RT groups, respectively. The a-TOT group had better results than the TOT and RT groups (p < 0.05 and p < 0.05), and besides, the difference between the TOT and RT groups was statistically significant (p < 0.05). According to percentage changes in domain scores following the operations, the a-TOT group had significantly better results in desire, arousal, lubrication, satisfaction, and pain domains than the TOT group (p < 0.05) as well as better desire, arousal, and pain domains (p < 0.05) than the RT group.

DISCUSSION/CONCLUSIONS

Besides comparable outcomes in SUI treatment, the a-TOT technique provides improvements in female sexual functions while TOT worsens and RT does not change. Favorable outcomes in sexual functions caused by improvements in desire, arousal, satisfaction, and pain domains are observed following the a-TOT technique.

Impact of transobturator vaginal tape on female stress urinary incontinence and sexual function

Objective

To evaluate the effect of vaginal transobturator tape (TOT) on female stress urinary incontinence (SUI) and sexual function.

Patients and methods

In all, 145 patients with SUI underwent TOT repair using the 'outside-in' technique. All patients had been sexually active in the previous 6 months. Patients were evaluated by history, routine laboratory investigations, cough stress test, abdominopelvic ultrasonography, and full urodynamic studies. The preoperative data assessed included: age, parity, body mass index, menopausal status, and Stamey grade of SUI. The intraoperative data assessed included: operative time, blood loss, and hospital stay; intra- and postoperative complications were also assessed. At 2 weeks after discharge, patients were followed-up with a routine examination and cough stress test. After 6 months' patients were assessed by urodynamic studies, maximum urinary flow rate, post-void residual urine volume. The following questionnaires were completed before and at 6 months after TOT insertion: International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), Urogenital Distress Inventory-Short Form (UDI-6), and Female Sexual Function Index (FSFI).

Results

All sociodemographic data of the 145 patients were collected. According to ICIQ-SF scores, 122 patients were cured, 19 had improved, and four failed. There were significant improvements in the UDI-6 and FSFI scores, indicating that the women had significant improvement in their sexual life. There were six cases of urinary tract infection, five cases had a fever, and eight patients complained of groin or thigh pain postoperatively.

Conclusions

Correction of SUI using TOT appears to have a positive effect on female sexual function.

Benefit of pelvic floor muscle therapy in improving sexual function in women with stress urinary incontinence: a pretest-posttest intervention study

Very few data are available on the effect of pelvic floor muscle training on sexual function in incontinent women. The authors used the Female Sexual Function Index to assess the effect of pelvic floor muscle training on female sexual function. Participants included women with stress urinary incontinence, without overactive bladder symptoms, who completed a 3-month pelvic floor muscle training. All patients completed the Female Sexual Function Index and the International Consultation on Incontinence Questionnaire-Short Form at baseline and at the 3-month follow-up. Thirty-four patients completed all of the questionnaires; 64.7% patients were referred with stress urinary incontinence without sexual disorders, while 35.3% complained of stress urinary incontinence and sexual symptoms. The International Consultation on Incontinence Questionnaire-Short Form score significantly decreased after 3 months of pelvic floor muscle training (p =.01). The Female Sexual Function Index score significantly improved after pelvic floor muscle training even in women with sexual disorders (12.5 ± 9.5 vs. 29.7 ± 3.7; p <.001). This study showed that pelvic floor muscle training may improve female sexual function in women with pure stress urinary incontinence.

Sexual function in women with stress urinary incontinence treated with the SPARC sling system

AIM

To evaluate the impact of SPARC on female sexual function.

METHODS

151 women with a mean age of 60 ± 11.90 and SUI had a complete urodynamic investigation and underwent SPARC operation. 98 women completed the validated female sexual function index questionnaire (FSFI) at baseline and 94 women at follow-up. A minimum follow-up of 12 months was required for study inclusion.

RESULTS

52/98 women were sexually active at baseline. Postoperatively only 33 patients were sexually active. The FSFI score of all 33 pre- and postoperative sexually active women increased from 25.3 ± 5.7 at baseline to 27.4 ± 4.8 at follow-up (P = 0.1). Scores of women with reduced sexual function at baseline increased significantly in the domains desire, arousal, and lubrication as well as orgasm and satisfaction and total FSFI-score (P = 0.002) postoperatively.

CONCLUSIONS

Our results suggest that the SPARC-sling procedure for SUI did not negatively interfere with female sexual function.

Complications of synthetic slings used in female stress urinary incontinence and applicability of the new IUGA-ICS classification

OBJECTIVES

To analyze different complications of synthetic suburethral slings, and to apply the new "IUGA-ICS classification of complications directly related to the insertion of prosthesis (meshes, implants, tapes) and grafts in female pelvic floor surgery" to the list of complications, check its applicability, and give suggestions regarding possible improvements.

STUDY DESIGN

This study is an analysis of complications of synthetic suburethral slings. Data on type of complication, time interval between the insertion of the prosthesis and the onset of symptoms of complication, type and nature of prosthesis, and management process were documented. Additional descriptions of the sling position in relation to lower urinary tract, shrinkage or prominence of the prosthesis, and intra-operative nature of the prosthetic material were collected for analysis.

RESULTS

From the year 2003 to 2010, 376 women with complications of synthetic suburethral slings were managed surgically and the data were analyzed. Overactive bladder (OAB) at 54%, lower urinary tract obstruction (48%), vaginal exposure (19%), and pain (14%) were the most frequent complications. Infection, fistulae, urinary tract penetration, and groin/thigh pain were other complications. The new IUGA-ICS classification could be applied to most of the types of complications, a notable exception being de novo development of overactive bladder. Also category 4B of IUGA-ICS classifications encompasses a wide clinical variety of complications and may need reconsideration.

CONCLUSION

De novo OAB seems to be the commonest complication of synthetic suburethral slings, followed by obstruction, vaginal exposure, and long term pain. The new IUGA-ICS classification on complications has good general applicability; some minor changes may be useful in the future.

The impact of mid-urethral slings for the treatment of urodynamic stress incontinence on female sexual function: a multicenter prospective study

INTRODUCTION

Urinary incontinence is a common condition that negatively impacts on female sexuality (FS).

AIM

To evaluate FS before and after a mid-urethral sling (MUS) procedure using the Female Sexual Function Index (FSFI). We included women that were both sexually and nonsexually active at baseline.

METHODS

One hundred fifty-seven women complaining of urodynamic stress incontinence underwent a MUS procedure and were enrolled in the study. All patients answered the Italian translation of FSFI, before and 12 months after surgery. To understand the real impact of the MUS on female sexual function, for the first time in the literature, we also monitored and included in the final analysis all the women who are nonsexually active at baseline. We evaluated the prevalence of female sexual dysfunction according to the FSFI cutoff point (26.55).

MAIN OUTCOME MEASURES

FSFI total score, pads use, and stress test presurgery and postsurgery.

RESULTS

One hundred thirty-three patients completed the study protocol: 105 out of 133 underwent to a trans-obturator procedure, while 28 out of 133 had a retropubic procedure. After the 12-month follow up, 115 out of 133 patients (86%) were dry, 10 improved their symptoms, and the remaining 8 were unchanged. Seventy-nine out of 133 (59%) patients reported an active sexual life before surgery. Fifty-four (41%) reported they were not sexually active before surgery. Twelve months after surgery, 22 out of 54 nonsexually active women (40%) reestablished sexual activity, whereas only 6 out of 79 (7.5%) patients, sexually active at baseline, were not sexually active 1 year after surgery (P < 0.05). After adjusting for multiple testing, only age, menopause, and storage symptoms remained significantly correlated with the FSFI total score postsurgery as independent variables. Conclusions.  Our data showed that after a MUS procedure, female sexual function improves. We also found that a very relevant percentage of nonsexually active women reported renewed sexual activity after MUS.

Urogenital complaints and female sexual dysfunction. Part 2

INTRODUCTION

Female sexual dysfunction (FSD) is common in women with urogenital disorders that occur as a result of pelvic floor muscle and fascial laxity.

AIM

Provide a comprehensive review of FSD as it relates to common urogenital disorders including pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and to discuss the impact of the surgical repair of these disorders on sexual function.

METHODS

Systematic search of the medical literature using a number of related terms including FSD, POP, SUI, surgical repair, graft augmentation, complications, and dyspareunia.

MAIN OUTCOME MEASURES

Review of the medical literature to identify the relation between FSD and common urogenital disorders in women and to describe appropriate treatment strategies to improve quality of life (QOL) and sexual function.

RESULTS

FSD is common in women with POP and SUI. Treatment options for POP and SUI include behavioral, pharmacological, and surgical methods which can also affect sexual function.

CONCLUSIONS

Sexual dysfunction is a common, underestimated complaint in women with POP and SUI. Treatment should be tailored toward improving sexual function and QOL. Surgical correction is generally beneficial but occasionally can result in negative alterations in sexual function. Patient selection and methods used for surgical repair are important factors in determining anatomical and functional success.

Female urinary incontinence at orgasm: a possible marker of a more severe form of detrusor overactivity. Can ultrasound measurement of bladder wall thickness explain it?

INTRODUCTION

Coital incontinence (CI) during orgasm is a form of urinary incontinence possibly because of detrusor overactivity (DO), as the underlying pathophysiological condition. Women with this symptom usually show a pharmacological lower cure rate than those with DO alone. The ultrasound measurement of the bladder wall thickness (BWT) allows an indirect evaluation of detrusor muscle thickness, giving a potential index of detrusor activity.

AIM

We wanted to understand if CI at orgasm could be a marker of severity of DO by comparing BWT in women with both DO and CI at orgasm vs. women with DO alone. In addition we aimed to confirm if CI during orgasm is related to antimuscarinics treatment failure.

METHODS

This is a prospective cohort study performed in two tertiary urogynecological referral departments, recruiting consecutive patients seeking treatment for symptomatic DO.

MAIN OUTCOME MEASURES

All patients were thoroughly assessed including physical examination, urodynamic evaluation, and BWT measurement according to the International Continence Society/International Urogynecological Association and ICI recommendations. Solifenacine 5 mg once daily was then prescribed and follow-up was scheduled to evaluate treatment. Multiple logistic regression (MLR) was performed to identify risk factors for treatment failure.

RESULTS

Between September 2007 and March 2010, 31 (22.6%) and 106 (77.4%) women with DO with and without CI at orgasm were enrolled. Women complaining of CI at orgasm had significantly higher BWT than the control group (5.8 ± 0.6 mm vs. 5.2 ± 1.2 mm [P=0.007]). In patients with CI at orgasm, the nonresponder rate to antimuscarinics was significantly higher than controls (P=0.01). After MLR, CI at orgasm was the only independent predictor decreasing antimuscarinics efficacy (odds ratio [OR] 3.16 [95% CI 1.22-8.18], P=0.02).

CONCLUSIONS

Women with DO and CI at orgasm showed a significantly higher BWT values and worse cure rates than women with DO alone. CI at orgasm could be a marker of a more severe form of DO.

Improvement of sexual function after transobturator tape procedure in women with stress urinary incontinence

Sling procedures are a widely proven treatment for stress urinary incontinence. The aim of this prospective study was to evaluate the effect of the transobturator tape on female sexual functioning. Fifty-four women treated for stress urinary incontinence with transobturator tape filled out self-administered questionnaires on quality of life, urinary incontinence, and sexual function prior to surgery and 6 weeks and 12 months postoperatively. Preoperatively, 40 women (78%) were sexually active. There were no significant postoperative changes regarding frequency of sexual activity, sexual desire, and problems with lubrication or orgasm. Preoperatively, 55% reported urinary leakage during sexual activity and after surgery 6.5%. Sexual satisfaction was significantly improved 6 weeks (p = 0.05) and 12 months (p = 0.03) postoperatively. Pain during or after sexual activity was declined, only one patient reported worsening of pain. The transobturator tape procedure has a positive effect on female sexual functioning by reducing urinary leakage and pain during or after sexual activity. It seems to improve the overall sexual satisfaction. Further research is warranted to support these preliminary findings.

Retropubic versus transobturator midurethral synthetic slings: does one sling fit all?

The purpose of this article is to evaluate the recent evidence base for the choice between transobturator and retropubic approaches to midurethral slings used to treat stress urinary incontinence. While the retropubic and transobturator approaches to midurethral sling surgery for stress urinary incontinence demonstrate equivalent efficacy across a number of randomized controlled trials, they do not appear to be equivalent when particular patient populations are considered separately. The retropubic approach appears to be a better option in patients with intrinsic sphincter deficiency and limited urethral mobility.

Perspectives by patients and physicians on outcomes of mid-urethral sling surgery

INTRODUCTION AND HYPOTHESIS

The aim of this study is to determine patient expectations regarding wanted and unwanted sequels of mid-urethral sling (MUS) procedures and to identify mismatches during the physician-patient information exchange prior to MUS procedures.

METHODS

A patient preference study (40 patients) and a questionnaire study with 20 experts as control group were conducted. Seventeen different sequels, defined by an expert team, were evaluated.

RESULTS

Both patients and expert physicians ranked cure and improvement of stress urinary incontinence as the most important goals of treatment. De novo urge urinary incontinence, requiring post-operative intermittent self-catheterisation and dyspareunia were considered to be the most important complications by patients. Time to resume work after the operation and dyspareunia were among the highest rated sequels in the patient group compared to re-operation and intra-operative complications in the expert group.

CONCLUSIONS

No differences were found in the five most important outcome parameters. In pre-operative counselling and future clinical trials, time to resume work and dyspareunia should be given more consideration by clinicians.