IMPACT OF MID URETHRAL SLING ON FEMALE SEXUAL FUNCTION. A PROSPECTIVE MULTICENTRE STUDY

INTRODUCTION AND OBJECTIVES: This multi-centre study evaluated sexual activity in a group of women with urodynamic stress incontinence (USI) before and after a Mid-Urethral Sling (MUS) procedure. METHODS: From September 2004 to April 2009, 133 women with USI underwent MUS (105 a trans-obturator (TOT) procedure; 28 a retropubic (TVT) procedure). Before surgery and 12 months afterwards all women underwent a urogynecological evaluation, urine analysis, ultrasound and urodynamic studies, kept bladder diaries and responded to an Italian translation of FSFI. Patients that referred no urine loss, no pad use and had a negative stress test were considered cured. Patient satisfaction was measured on a VAS scale (1 was minimum satisfaction and 10 maximum). Statistical analysis was performed with Mann Whitney and Wilcoxon tests and Spearman's correlation coefficient test. Multivariate analysis evaluated significant and independent variables. RESULTS: One year after surgery 86% were dry while 14% were wet. Ten of the 18 incontinent women were improved, and 8 were unchanged. Mesh revision due to vaginal erosion was carried out in 3 patients, other 2 patients had sling sections due to voiding difficulties. 7 patients (5.2%) referring de novo urgency needed anti-cholinergic treatment. Another 22 patients complained of storage symptoms but did not need treatment. Before surgery 53/133 women (39%) were not sexually active. One year after surgery sexual activity was restored in 37/53 women. Pre-operatively sexual activity was normal (FSFI>26.55) in 35/80 (43%) women. After surgery 7/80 sexually active women became inactive and 46/96 sexually active women (47%) had a normal sexuality (FSFI>26.55). Analysis of FSFI total scores and all questionnaire sub-scores demonstrated a significant improvement in sexual function either after the TVT or TOT (p<0.0001) procedure, but no significant difference between the two approaches (p>0.05). The majority of patients (78%) declared they were satisfied and would repeat the procedure. Significant correlations were found between the FSFI total score and educational level, menopause, continence status and post-operative storage dysfunctions. After multivariate analysis only menopause and storage symptoms remained significant and independent variables CONCLUSIONS: Sexual activity improved significantly in patients who underwent a successful sling procedure for USI. Assessment of sexual function, an important parameter of female quality of life, should be mandatory in women treated for USI Source of Funding: none