Sexual function improves after stress urge incontinence surgery

Chicago-Sexual function improves in women after successful surgery for stress urinary incontinence (SUI) whether they undergo a sling procedure or Burch colpopsuspension, according to 2-year results from the prospective, multicenter Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) presented at the American Urogynecologic Society annual scientific meeting here.

SISTEr randomized 655 women in the operating room to undergo either a rectus fascial pubovaginal sling procedure or Burch colposuspension. Change in sexual function was a planned secondary analysis of the study and was assessed by administering the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ) at baseline and at 2 years after surgery or before SUI re-treatment.

The results showed a statistically significant decrease in the proportion of sexually active women who reported incontinence preoperatively compared with at follow-up: 53% versus 9%. In addition, there was a statistically significant decrease in the proportion of women who reported restriction of sexual activity due to fear of incontinence preoperatively compared with postoperatively: 52% versus 10%. Improvement in sexual function correlated with successful surgery in both treatment groups.

"Women whose sex life is suffering because of incontinence can be reassured this is common and they are not alone, and they can be encouraged that if they have a good outcome from surgery in terms of improving their incontinence, there is a good chance their sex life will also get better," Dr. Brubaker said. "The fact that improvement occurred in both study groups among women who had a successful response to surgery indicates that it is the development of continence and not the procedure per se that accounts for the improved sexual function."

Dr. Brubaker noted that the relationships among sexual function, SUI, and its treatment have not been widely studied in a well-defined patient population, and that a validated instrument for investigating these issues has also been lacking.

"SISTEr is one of the first studies in this area. Its strengths include the size of its population, length of follow-up, and use of a sexual function questionnaire specifically validated for women with prolapse and incontinence," Dr. Brubaker said.

Eligibility criteria for SISTEr required women to have stress predominant urinary incontinence symptoms, a positive cough/Valsalva stress test, urethral hypermobility on Q-tip exam, and a desire for surgical treatment for incontinence.

At baseline, 450 of the 655 study participants reported having sexual activity with a partner and answered at least 10 of the 12 items on the PISQ. Comparisons of women who were sexually active and those who were not showed statistically significant differences in mean age (49.5 vs. 57.4 years), body mass index (29.2 vs. 31.6), and measures of incontinence severity, including total Medical Epidemiologic and Social Aspects of Aging (MESA) score (25.4 vs. 26.7), MESA urge subscale score (5.2 vs. 7.1), and pad weight (38.2 vs. 55.3 grams).

Among sexually active women, mean PISQ score was 32.23 at baseline and increased to 36.85 at follow-up. Results from PISQ subscales showed significant reductions from pre- to postoperatively in the women who reported avoiding intercourse because of vaginal bulging (24% vs. 3%) and having negative emotional reactions during sex (35% vs. 9%).

Improvement in sexual function did not correlate with the prolapse stage preoperatively based on the prolapse quantification or whether the woman had concomitant surgery for vaginal prolapse.

The UITN is a clinical trials network created by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to obtain higher levels of evidence about incontinence treatments.