Objective: To evaluate the effects of four different surgical interventions for stress urinary incontinence (SUI) on 2-year postoperative sexual function.
Methods: This is a combined secondary analysis of SISTEr (Stress Incontinence Surgical Treatment Efficacy Trial) and TOMUS (Trial of Mid-Urethral Slings). Women in the original trials were randomized to receive surgical treatment for SUI with an autologous fascial sling or Burch colposuspension (SISTEr), or a retropubic or transobturator midurethral sling (TOMUS). Sexual function (assessed by the short version of the PISQ-12 [Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire]) was compared between groups at baseline, 12 and 24 months. Secondarily, the effects of subjective and objective surgical cure rates and the effect of concomitant surgical procedures on 24-month sexual function was explored.
Results: Nine hundred twenty-four women were included in this study: 249 (26.9%) had an autologous fascial sling, 239 (25.9%) underwent Burch colposuspension, 216 (23.3%) had a retropubic midurethral sling placed, and 220 (23.8%) had transobturator midurethral sling placed. Baseline characteristics (including PISQ-12 scores) were similar between the four treatment arms, with notable exceptions including race-ethnicity, prolapse stage, concomitant surgery, and number of vaginal deliveries. After adjustment for differences between the groups, there was a clinically important improvement in PISQ-12 scores over the 24-month postoperative period for all treatment groups, with no significant differences attributed to the type of anti-incontinence procedure (baseline PISQ-12: 32.6, 33.1, 31.9, 31.4; 24-month PISQ-12: 37.7, 37.8, 36.9, 37.1, P<.01). There was no significant difference in mean PISQ-12 scores between 12 months and 24 months (12-month PISQ-12: 37.7, 37.8, 36.9, 37.1; 24 months as above, P=.97). Multivariable analysis showed independent associations between objective and subjective cure rates as well as concomitant procedures with a 24-month PISQ-12 score.
Conclusion: Women undergoing anti-incontinence surgery show overall improvement in sexual function from baseline to 24 months postoperatively, without significant differences based on surgical procedure performed. The majority of this improvement occurs in the first 12 months and is maintained over 24 months.
Female Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis.Sex Med Rev. 2018 Apr;6(2):224-233. doi: 10.1016/j.sxmr.2017.10.005. Epub 2017 Dec 28. Sex Med Rev. 2018. PMID: 29289535
Short-term effect of TVT-SECUR procedure on quality of life and sexual function in women with stress urinary incontinence.J Minim Invasive Gynecol. 2013 Jul-Aug;20(4):455-9. doi: 10.1016/j.jmig.2013.01.006. Epub 2013 Mar 15. J Minim Invasive Gynecol. 2013. PMID: 23506715
Surgery for women with pelvic organ prolapse with or without stress urinary incontinence.Cochrane Database Syst Rev. 2018 Aug 19;8(8):CD013108. doi: 10.1002/14651858.CD013108. Cochrane Database Syst Rev. 2018. PMID: 30121956 Free PMC article. Review.
[Study of sexual function in women after surgery for stress urinary incontinence].Zhonghua Fu Chan Ke Za Zhi. 2006 Apr;41(4):253-7. Zhonghua Fu Chan Ke Za Zhi. 2006. PMID: 16759461 Chinese.
Management of recurrent stress urinary incontinence after burch and sling procedures.Neurourol Urodyn. 2016 Mar;35(3):344-8. doi: 10.1002/nau.22714. Epub 2015 Jan 16. Neurourol Urodyn. 2016. PMID: 25598512 Free PMC article. Review.