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Table 3 Effect of surgical treatments of stress urinary incontinence on sexual function

From: Impact of urinary incontinence on female sexual health in women during midlife

Study Design N Treatment Length of Follow Up (months) Instrument Findings Coital Incontinence
Overall Post-Operative Sexual Function Improved Worsened No Difference
Midurethral sling: Retropubic (TVT)
Jha et al [62] Prospective case series 62 TVT 3 ePAQ N/A • Impact of LUTS on sex (p < 0.001) N/A • Partner avoidance of sex (p = 0.06) • Improved (p < 0.001)
• Avoidance of sex (p < 0.001)
• Anxiety of UI & sex (p < 0.001)
Ghezzi et al [70] Prospective case series 53 TVT 6-12 PISQ • Improved: 34 % N/A N/A • Fear of incontinence • Improved in 87 %, with associated improvement:
• Worsened: 3.8 % • Frequency • Frequency
• Fear of CI
• Embarrassment
Midurethral sling: Retropubic (TVT) versus Transobterator (TVT-O, TOT) comparative studies
Elzevier et al [71] Prospective cohort 1. TVT-O: 34 1. TVT-O 3-4 Lemack • Improved: 20.6 & 18.2 % (TVT, TVT-O respectively) N/A • Dyspareunia from vaginal narrowing in TOT [vs TVT-O] (p = 0.026) • Frequency • Improved
2. TOT: 44 2. TOT • Worsened: 5.9 & 18.2 % (TVT, TVT-O respectively   • Lubrication loss (p = 0.612)
• Clitoral lumescence reduction, sensibility (p = 0.191, p = 0.346 respectively)
Jha et al [64] Prospective cohort 1. TVT: 43 1. TVT 6 PISQ N/A • Total PISQ (p < 0.001) N/A • Behavior emotive subdomain (p = 0.7) • Improved (p < 0.002)
2. TVT-O: 11 2. TVT-O     • Partner, Physical subdomains (p = 0.002, p < 0.001 respectively)
Zyczynski et al [67] RCT 1. TVT: 298 1. TVT 24 PISQ N/A • Total PISQ (p < 0.0001) • PISQ in surgical failure [vs success] (p = 0.009) • PISQ between TVT & TOT • Improved (p < 0.0001)
2. TOT: 299 2. TOT • Pain (p = 0.003) • Proportion of sexually active patients post-op
• Fear of UI & sex (p < 0.0001)
Filocamo et al [61] Prospective cohort 1. TVT: 28 1. TVT 12 FSFI N/A • Total FSFI (p < 0.002) N/A • FSFI between TVT & TOT N/A
2. TOT: 105 2. TOT • All subdomains (p < 0.002)
• Sexual dysfunction (P = 0.05)
Cayan et al [75] Prospective cohort 1. TVT or vaginal repair: 53 1. TVT or vaginal repair 1. Sling: 32.1 +/- 13.7 FSFI • Improved: 24.5 & 12.2 % (TVT, Burch respectively) N/A • Total FSFI (p < 0.001) • Pain (p = 0.162) N/A
2. Burch: 41 2. Burch 2. Burch: 35.7 +/- 16.7 • Worsened: 47.2 & 63.4 % (TVT, Burch respectively) • Desire, arousal, lubrication, orgasm, satisfaction subdomains (p ≤ 0.002)
• Total FSFI, desire, arousal, lubrication, orgasm in Burch [vs TVT] (p = 0.004-0.026)
Periurethral bulking injection
Leone Roberti Maggiore et al [76] Prospective case series 29 Polyacrylamide hydrogel periurethral injection 12 PISQ, Global sexual satisfaction VAS score N/A • Total PISQ (p < 0.001) • Global sex satisfaction in surgical failure [vs success] (p < 0.001) • Pain (p = 0.244) • Improved (p < 0.001)
• Desire, orgasm frequency, excitation, satisfaction, fear of UI & sex, negative emotional reaction, orgasm intensity (p < 0.001)
• Global sex satisfaction VAS score (p < 0.001)
  1. CI Coital incontinence; ePAQ Electronic Pelvic Floor Symptoms Assessment Questionnaire; FSFI Female sexual function index; PISQ Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire; RCT Randomized controlled trial; SA Sexually active; TVT Tension-free vaginal tape; TVT-O Tension-free vaginal tape - obturator; TOT transobturator tape; VAS visual analog scale