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Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies.
J Sex Med. 2020 10; 17(10):1956-1970.JS

Abstract

BACKGROUND

Stress urinary incontinence (SUI) is a common, distressing health issue which affects many women. Mid-urethral sling (MUS) surgeries are recommended as gold standard interventions, although evidence regarding their impact on female sexual function remains controversial.

AIM

To provide high-quality evidence of the impact of MUS surgeries on sexual functions in women with SUI.

METHODS

A systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies assessing the effect of MUS treatments on sexual functions in women with SUI. The included studies were prospective randomized or non-randomized trials which assessed patients using 2 validated questionnaires, the Female Sexual Function Index (FSFI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Pre- and postoperative data regarding sexual function were extracted. Meta-analysis of comparable data was performed using Review Manager (version 5.3) software.

MAIN OUTCOME MEASURES

The relationship between MUS interventions and sexual functions was analyzed by pooling weighted mean differences (WMD) with 95% CI from studies which used either the FSFI or PISQ-12 questionnaires, before and after receiving surgical interventions.

RESULTS

Of the 22 eligible studies, 13 utilized FSFI and 9 adopted the PISQ-12. Pooled analysis indicates that 6-month postoperative PISQ-12 scores were significantly higher than preoperative scores (WMD -3.31 points; 95% CI -5.32 to -1.30; P = .001). Similar results were found at the 12-month juncture (WMD -3.30 points; 95% CI -6.01 to -0.58; P = .02) and at 24 months (WMD -4.44 points; 95% CI -5.45 to -3.44; P < .00001). Likewise, pooled postoperative FSFI total scores were significantly higher than preoperative scores at 6 months (WMD -2.22 points; 95% CI -3.36 to -1.08; P = .00001) and 12 months (WMD -3.49 points; 95% CI -5.96 to -1.02; P = .006). Postoperative FSFI sub-scores also suggest that desire, arousal, orgasm, lubrication, satisfaction, and pain during sexual intercourse significantly improved postoperatively (all P < .05). Moreover, combined evidence highlighted a significant reduction in coital incontinence postoperatively (risk ratio 5.78; 95% CI 3.16-10.58; P < .00001).

CLINICAL IMPLICATIONS

These assessment tools might be more appropriately used to create opportunities for counseling.

STRENGTHS & LIMITATIONS

We encountered substantial heterogeneity and insufficient long term follow-up data. There is also a distinct lack of standards, in terms of data recording and reporting across this evidence base which adds to the problems with the PISQ-12 and FSFI which, even though validated, appear unsophisticated and not necessarily fit-for-purpose.

CONCLUSION

This meta-analysis confirms that sexual functions do improve after MUS surgeries for women with SUI. Lai S, Diao T, Zhang W, et al. Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies. J Sex Med 2020;17:1956-1970.

Authors+Show Affiliations

Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Peking University Fifth School of Clinical Medicine, Beijing, China.Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Peking University Fifth School of Clinical Medicine, Beijing, China.School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Peking University Fifth School of Clinical Medicine, Beijing, China.Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Peking University Fifth School of Clinical Medicine, Beijing, China.Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. Electronic address: wangjy@bjhmoh.cn.Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. Electronic address: zhang003887@sina.com.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

32741744

Citation

Lai, Shicong, et al. "Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: a Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies." The Journal of Sexual Medicine, vol. 17, no. 10, 2020, pp. 1956-1970.
Lai S, Diao T, Zhang W, et al. Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies. J Sex Med. 2020;17(10):1956-1970.
Lai, S., Diao, T., Zhang, W., Seery, S., Zhang, Z., Hu, M., Meng, L., Ma, T., Liu, X., Wang, J., & Zhang, Y. (2020). Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies. The Journal of Sexual Medicine, 17(10), 1956-1970. https://doi.org/10.1016/j.jsxm.2020.07.003
Lai S, et al. Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: a Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies. J Sex Med. 2020;17(10):1956-1970. PubMed PMID: 32741744.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies. AU - Lai,Shicong, AU - Diao,Tongxiang, AU - Zhang,Wei, AU - Seery,Samuel, AU - Zhang,Zhipeng, AU - Hu,Maolin, AU - Meng,Lingfeng, AU - Ma,Tianming, AU - Liu,Xiaodong, AU - Wang,Jianye, AU - Zhang,Yaoguang, Y1 - 2020/07/30/ PY - 2020/04/30/received PY - 2020/06/25/revised PY - 2020/07/03/accepted PY - 2020/8/4/pubmed PY - 2020/12/22/medline PY - 2020/8/4/entrez KW - Female Sexual Function Index KW - Mid-Urethral Sling KW - Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire KW - Sexual Function KW - Urinary Incontinence SP - 1956 EP - 1970 JF - The journal of sexual medicine JO - J Sex Med VL - 17 IS - 10 N2 - BACKGROUND: Stress urinary incontinence (SUI) is a common, distressing health issue which affects many women. Mid-urethral sling (MUS) surgeries are recommended as gold standard interventions, although evidence regarding their impact on female sexual function remains controversial. AIM: To provide high-quality evidence of the impact of MUS surgeries on sexual functions in women with SUI. METHODS: A systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies assessing the effect of MUS treatments on sexual functions in women with SUI. The included studies were prospective randomized or non-randomized trials which assessed patients using 2 validated questionnaires, the Female Sexual Function Index (FSFI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Pre- and postoperative data regarding sexual function were extracted. Meta-analysis of comparable data was performed using Review Manager (version 5.3) software. MAIN OUTCOME MEASURES: The relationship between MUS interventions and sexual functions was analyzed by pooling weighted mean differences (WMD) with 95% CI from studies which used either the FSFI or PISQ-12 questionnaires, before and after receiving surgical interventions. RESULTS: Of the 22 eligible studies, 13 utilized FSFI and 9 adopted the PISQ-12. Pooled analysis indicates that 6-month postoperative PISQ-12 scores were significantly higher than preoperative scores (WMD -3.31 points; 95% CI -5.32 to -1.30; P = .001). Similar results were found at the 12-month juncture (WMD -3.30 points; 95% CI -6.01 to -0.58; P = .02) and at 24 months (WMD -4.44 points; 95% CI -5.45 to -3.44; P < .00001). Likewise, pooled postoperative FSFI total scores were significantly higher than preoperative scores at 6 months (WMD -2.22 points; 95% CI -3.36 to -1.08; P = .00001) and 12 months (WMD -3.49 points; 95% CI -5.96 to -1.02; P = .006). Postoperative FSFI sub-scores also suggest that desire, arousal, orgasm, lubrication, satisfaction, and pain during sexual intercourse significantly improved postoperatively (all P < .05). Moreover, combined evidence highlighted a significant reduction in coital incontinence postoperatively (risk ratio 5.78; 95% CI 3.16-10.58; P < .00001). CLINICAL IMPLICATIONS: These assessment tools might be more appropriately used to create opportunities for counseling. STRENGTHS & LIMITATIONS: We encountered substantial heterogeneity and insufficient long term follow-up data. There is also a distinct lack of standards, in terms of data recording and reporting across this evidence base which adds to the problems with the PISQ-12 and FSFI which, even though validated, appear unsophisticated and not necessarily fit-for-purpose. CONCLUSION: This meta-analysis confirms that sexual functions do improve after MUS surgeries for women with SUI. Lai S, Diao T, Zhang W, et al. Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies. J Sex Med 2020;17:1956-1970. SN - 1743-6109 UR - https://www.unboundmedicine.com/medline/citation/32741744/Sexual_Functions_in_Women_With_Stress_Urinary_Incontinence_After_Mid_Urethral_Sling_Surgery:_A_Systematic_Review_and_Meta_Analysis_of_Prospective_Randomized_and_Non_Randomized_Studies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1743-6095(20)30728-1 DB - PRIME DP - Unbound Medicine ER -