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Effect of Surgery for Stress Incontinence on Female Sexual Function.
Obstet Gynecol. 2020 02; 135(2):352-360.OG

Abstract

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.

Authors+Show Affiliations

Department of Obstetrics and Gynecology and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Virginia Commonwealth University Health System, and the Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

31923066

Citation

Glass Clark, Stephanie M., et al. "Effect of Surgery for Stress Incontinence On Female Sexual Function." Obstetrics and Gynecology, vol. 135, no. 2, 2020, pp. 352-360.
Glass Clark SM, Huang Q, Sima AP, et al. Effect of Surgery for Stress Incontinence on Female Sexual Function. Obstet Gynecol. 2020;135(2):352-360.
Glass Clark, S. M., Huang, Q., Sima, A. P., & Siff, L. N. (2020). Effect of Surgery for Stress Incontinence on Female Sexual Function. Obstetrics and Gynecology, 135(2), 352-360. https://doi.org/10.1097/AOG.0000000000003648
Glass Clark SM, et al. Effect of Surgery for Stress Incontinence On Female Sexual Function. Obstet Gynecol. 2020;135(2):352-360. PubMed PMID: 31923066.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Surgery for Stress Incontinence on Female Sexual Function. AU - Glass Clark,Stephanie M, AU - Huang,Qi, AU - Sima,Adam P, AU - Siff,Lauren N, PY - 2020/1/11/pubmed PY - 2020/6/24/medline PY - 2020/1/11/entrez SP - 352 EP - 360 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 135 IS - 2 N2 - 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. SN - 1873-233X UR - https://www.unboundmedicine.com/medline/citation/31923066/Effect_of_Surgery_for_Stress_Incontinence_on_Female_Sexual_Function_ L2 - https://doi.org/10.1097/AOG.0000000000003648 DB - PRIME DP - Unbound Medicine ER -