The effect of transobturator tape operation on sexual functions of a patient with stress urinary incontinence and patient's spouse

Spouses Speak Up: The Impact of Mesh Sling Complications on the Patient's Spouse-A Qualitative Analysis Study

OBJECTIVE

To examine the perspectives, attitudes, and beliefs of the spouses of women with complications of mesh midurethral sling (MUS) surgery with the goal of increasing our understanding of the multidimensional nature of MUS surgery complications.

METHODS

After IRB approval, the spouses of patients who underwent surgery for MUS complications at a single tertiary care institution participated in qualitative interviews. Using an interview guide with standardized prompts, semistructured interviews were conducted. Interviews were transcribed verbatim and reviewed line-by-line by two researchers independently. Inductive content analysis was used to code the transcripts and identify themes, and consensus was achieved by the research team.

RESULTS

Seven male spouses participated in qualitative interviews, and several themes and subthemes were identified. First, spouses expressed feelings of regret. They described that their partner's dyspareunia detracted from their intimate relationship. The participants also reported the negative impact on their lives and their households. Due to the personal nature of the issue, couples would avoid involving friends and family, creating a sense of isolation. Finally, they expressed hope of finding a healthcare team experienced with mesh complications and invested in their spouse's improvement.

CONCLUSION

Spouses of women who experience MUS complications serve as caregivers and provide support; they are impacted by adverse outcomes. It is important to acknowledge their role in patients' healthcare experiences and learn from their insights. Our study lays the foundation for future work and ultimately for improving the experiences of patients and their spouses with MUS surgery and potential complications.

Impact of female stress urinary incontinence and related treatments on the sexual function of male partners: a systematic review and meta-analysis

BACKGROUND

No conclusions have been reached on whether female stress urinary incontinence (SUI) and related treatments affect male partners' sexual function.

AIM

To assess the effects of female SUI and related treatments on male partners' sexual function.

METHODS

A comprehensive search of the PubMed, Embase, Web of Science, Cochrane, and Scopus databases was performed up to September 6, 2022. Studies were included that investigated the effect of female SUI and related treatments on male partners' sexual function.

OUTCOME

Male partners' sexual function.

RESULTS

Of the 2294 citations identified, 18 studies with 1350 participants were included. Two studies assessed the effect of female SUI without treatment on male partners' sexual function, finding that partners had more erectile dysfunction, more sexual dissatisfaction, and less sexual frequency than partners of women without urinary incontinence. Seven studies directly assessed the effect of female SUI treatments on male partners' sexual function by surveying the male partners. Among these, 4 assessed transobturator suburethral tape (TOT) surgery; 1 assessed TOT and tension-free vaginal tape obturator surgery; and the remaining 2 assessed pulsed magnetic stimulation and laser treatment. Among the 4 TOT studies, 3 used the International Index of Erectile Function (IIEF). TOT surgery significantly improved the total IIEF score (mean difference [MD] = 9.74, P < .00001), along with erectile function (MD = 1.49, P < .00001), orgasmic function (MD = 0.35, P = .001), sexual desire (MD = 2.08, P < .00001), intercourse satisfaction (MD = 2.36, P < .00001), and overall satisfaction (MD = 3.46, P < .00001). However, the improvements in IIEF items may be of unclear clinical significance, as 4 points in the erectile function domain of the IIEF are typically defined as the minimal clinically important difference. In addition, 9 studies indirectly assessed the effect of female SUI surgery on male partners' sexual function by surveying patients with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. The results demonstrated no significant differences in erectile function (MD = 0.08, P = .40) or premature ejaculation (MD = 0.07, P = .54).

CLINICAL IMPLICATIONS

The effects of female SUI and related treatments on male partners' sexual function were summarized for the first time, providing a reference for future clinical practice and scientific research.

STRENGTHS AND LIMITATIONS

A limited number of studies that used various scales met the standardized eligibility criteria.

CONCLUSION

Female SUI may affect male partners' sexual function, and female patients' anti-incontinence surgery does not appear to have a clinically significant improvement on the sexual function of their partners.

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.

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

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.