Study design, materials and methods
This retrospective study involved female patients diagnosed with stress urinary incontinence. Each patient underwent a midurethral sling surgery between August 2015 and September 2023. They were categorised into one of two groups based on the surgical technique employed: TOR or RPR. Specifically, a transobturator tape (TOT) and a tension-free vaginal tape (TVT) are utilised for these respective routes.
It is important to consider that all surgeries were conducted at the same centre and were performed by the same urology team like day cases procedures.
A total of 163 midurethral sling surgeries were performed in this period. However, patients with a history of myelomeningocele, medullary injury, pelvic trauma, neurogenic bladder, neobladder, bladder enlargement, autologous sling and those aged over 60 years were excluded from the study. (Figure 1)
Inclusion criteria were:
- Female patients below 60 years.
- Undergoing midurethral sling surgery for SUI.
- Surgical technique: TOR or RPR
All the women undergoing the midurethral sling procedure included in this study were instructed to complete the Female Sexual Function Index short version in Spanish questionnaire (sFSFI-sv) six months after the surgery. This questionnaire is a 6-item spanish version and was based on existing items of the FSFI, aimed at targeting the six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) of female sexual function. Each domain is assigned a minimum and a maximum score, and the total score for sexual function is determined from all domains. (1, 2).
Results
The 62 patients included were aged between 34 to 60 years, with a median of 49,4 years. Of the total slings placed, 19 (30,6%) were via the RPR whereas the TOR was used in 43 patients (69,4%).
Table 1 displays the demographic characteristics. There were no differences found among groups concerning preoperative, intraoperative, and postoperative factors.
The average sFSFI-sv total score observed was 27 (Score range: 2-30).
Regarding pain, only two individuals reported a score of 1, representing 3,2% of the total. Furthermore, these women were identified as being inside the group with TOR. This information suggests that a really small proportion of women reported a low score for pain in the sFSFI-sv. Additionally, two women indicated a score of 0 (3,2%). They explained that they abstained from engaging in sexual relations due to religious reasons.
Concerning satisfaction with their sexual life, just two patients, constituting 3,2% of the entire sample, reported a score of 1. These women were classified as part of the group with TOR. In relation to this specific domain, four women indicated experiencing discomfort during vaginal penetration more than a half of times (6,4%). Three of them were categorised within the group with TOR, while one was in the RPR group.
When comparing the TOR group to the RPR group, no significant difference was observed. The median variance was 0.34 points, ranging from 0.19 to 0.67 points. The largest variance (0.67 points) was observed in the lubrication domain, while the smallest variance (0.19 points) was found in the pain domain. (Table 2)
Interpretation of results
These findings suggest a positive overall post-surgery sexual experience, with scores leaning towards the higher end of their respective range. Moreover, a really small proportion of women reported a low score for pain in the sFSFI-sv.
It is essential to note that a significant proportion of the women included in the study are satisfied with their sexual life postoperatively.