Tension-Free Tape Repair May Boost Sexual Function Related to Stress Incontinence

By Marilynn Larkin

July 16, 2020

NEW YORK (Reuters Health) - Slingplasty with tension-free vaginal tape (TVT) improved sexual function in women with stress urinary incontinence in a study in China.

Dr. Lan Zhu and colleagues at Peking Union Medical College Hospital studied 105 sexually active women with stress urinary incontinence who underwent TVT surgery. The mean age was 51 and about half were menopausal. Participants completed The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form (PISQ-12) pre- and postoperatively.

As reported in Menopause, one year after TVT surgery, sexual function improved in 81 (77.1%) participants, remained unchanged in 18 (17.1%), and deteriorated in six (5.7%).

"Success" with respect to sexual function was defined as ''very much better''; other results were defined as failure.

In the success group, the mean PISQ-12 score increased significantly from 29.96 at baseline to 33.53 at one-year follow-up.

By contrast, in the failure group, the PISQ-12 score increased from 27.25 to 29.25, a nonsignificant difference.

While there was marked improvement in the physical domain of the PISQ-12, regardless of success or failure, the emotional and partner-related domains showed no significant changes. Therefore, the authors note that the increase in the physical domain score caused the increase the total PISQ-12 score.

Compared with preoperative values, there was no significant change in the score of pain during sexual intercourse at one year after TVT. However, women experienced less fear of incontinence during intercourse and less negative emotional reactions during intercourse after TVT than before.

Further, more than 90% of women in the success group said they "never" experienced coital incontinence versus 50% in the failure group.

Dr. Zhu did not respond to requests for a comment, but three US-based experts commented in emails to Reuters Health.

Dr. Harvey Winkler, System Chief, Fellowship in Female Pelvic Medicine and Reconstructive Surgery: Urogynecology at Northwell Health in New York, said, "This paper adds to the important growing body of evidence that a retropubic midurethral sling, such as the TVT, improves sexual function in sexually active women suffering from stress urinary incontinence."

One-year outcomes are "adequate and acceptable" to assess sexual function, he noted. "Sexual function is multifactorial and as time progresses from the index procedure, it is difficult to control for changing variables such as aging. Conversely, if the TVT procedure adversely affects sexual function in a negative manner, we would expect that to occur rather shortly after the procedure."

"Patients who have mixed (stress and urge) urinary incontinence and have a predominant component of urge incontinence should have the urge component treated first, prior to the placement of a TVT sling," he added.

Dr. R. Mark Ellerkmann, Director of Urogynecology at Mercy Medical Center in Baltimore said, "Lower urinary tract disorders such as stress urinary incontinence, overactive bladder, and painful bladder syndrome are all associated with sexual dysfunction. Although data directly comparing the treatment modalities are limited, behavioral, medical and surgical interventions for SUI have been associated with sexual function improvement."

"Conservative interventions, such as pelvic floor physical therapy and modest weight loss in patients who are obese, can been highly effective in minimizing the severity of stress urinary incontinence which, in turn, can improve sexual dysfunction, thus potentially negating the need to proceed with surgical intervention," he noted.

Dr. Melissa Laudano, a urologist at Montefiore Health System in New York City, commented, "Similar results highlighting the improvement in female sexual function following surgery for stress urinary incontinence have been reported; however, of note, this study...utilizes a validated sexual function questionnaire specifically addressing sexual dysfunction in patients with urinary incontinence and pelvic floor disorders. It highlights the importance for clinicians to include questions regarding sexual dysfunction in both the pre- and postoperative assessment."

"Some patients are not ideal candidates for TVT surgery," she added. "Special consideration should be given to patients who desire future fertility/childbearing, have a history of mesh erosions or pelvic radiation, have urethral pathology such as a urethral diverticulum, or whose personal preference is to avoid mesh."

SOURCE: https://bit.ly/30ihDQG Menopause, online June 29, 2020.