Impact of surgery for stress urinary incontinence on sexuality

Chermiti Amal, Frikha Hatem , Aloui Haithem, Hammami Rami, Ben Dhiaf Zeineb ,Laamiri Hadir , Binous Mehdi, Chennoufi Mohamed Bedis, Abouda Hsine Sabeur Maternity and Neonatology Center of Tunis

Objective: to evaluate the women sexuality after surgical treatment of stress urinary incontinence (SUI) and analyze the satisfaction of these patients.

Design: a prospective descriptive and analytic study

Methods: we proceeded by a monocentric prospective study including women who were operated in our department for SUI with sub urethral slings by the trans obturator approach with evaluation 6 months after surgery. Global satisfaction was evaluated using patient global impression and improvement (PGI-I), urinary symptoms were assessed using the ICIQ-FLUTS and sexuality was appreciated by Lemack and Ziemmern survey and ICIQ FLUTSsex

Results: we received 20 responses (85.4% of women) . the average age was 57 years old (+-11). After the surgery, the PGI-I revealed that 17 woman felt better (85% of cases) , 10% had not noticed any change and 5% felt worse . Among the 18 women sexually active, 7 (38.9%) noticed improvement in their sexual life while 2 had no more sexual life. The 7 women sexually satisfied reported that intercourse incontinence decreased in 60.2% of cases while the two unsatisfied complained of dyspareunia. The global improvement after surgery was not only concerning incontinence (RR0.93) but also in sexuality (RR 13.85)

Discussion : Many studies have evaluated the impact of MUS surgery on sexual function (1) A meta-analysis combining results of 23 studies demonstrated that the majority (67%) of women that underwent SUI surgery experienced unchanged or improved sexual function(2). Improvement was due to resolution of intercourse incontinence (3). While woman who felt sexually worse reported dyspareunia(3,4)

Limitations: While this study provides valuable insights into postoperative outcomes, several limitations should be considered. Firstly, the absence of a control group limits the ability to make direct comparisons and attribute outcomes solely to the surgical intervention. Additionally, the study relied on self-report questionnaires, which are subject to subjective interpretation and recall bias

Conclusion : among women operated for SUI using suburethral slings one third reported an improvement of their sexuality and life quality

References : 1-Sarreau M, et al. Sexualité après cure d’incontinence urinaire par bandelette sous-urétrale transobturatrice et satisfaction des patientes. Prog Urol (2015), http://dx.doi.org/10.1016/j.purol.2015.10.003 2-Pizzol D, Demurtas J, Celotto S, Maggi S, Smith L, Angiolelli G, Trott M, Yang L, Veronese N. Urinary incontinence and quality of life: a systematic review and meta-analysis. Aging Clin Exp Res. 2021 Jan;33(1):25-35. doi: 10.1007/s40520-020- 01712-y. Epub 2020 Sep 22. PMID: 32964401; PMCID: PMC7897623. 3-The effects of stress incontinence surgery on sexual function and life quality of women July 2016 DOI:10.4081/aiua.2016.2.106 4-Nakayama N, Tsuji T, Aoyama M, Fujino T, Liu M. Quality of life and the prevalence of urinary incontinence after surgical treatment for gynecologic cancer: a questionnaire survey. BMC Womens Health. 2020 Jul 17;20(1):148. doi: 10.1186/s12905-020-01012-7. PMID: 32680500; PMCID: PMC7367359