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TVT, TOT incontinence repairs aid sex function.

SAVANNAH, GA. -- Surgical repair of stress urinary incontinence using either transobturator tape or tension-free vaginal tape significantly improved physical aspects of sexual function at 1 year, based on the secondary analysis of a study involving 170 women.

"Questions that addressed physical factors--urinary incontinence with intercourse, fear of incontinence that restricted sexual activity, and avoidance of sexual intercourse because of prolapse--as well as adverse emotional reactions (such as fear, shame, disgust, and guilt) all statistically improved following surgery," Dr. R. Mark Ellerkmann of Greater Baltimore Medical Center said at the annual meeting of the Society of Gynecologic Surgeons.

Dr. Ellerkmann and his colleagues had previously reported the study's primary outcome, that repair of stress urinary incontinence (SUI) using the Monarc transobturator tape was not inferior to repair using tension-free vaginal tape in women with or without pelvic organ prolapse (Obstet. Gynecol, 2008;111:611-21).

The study was supported by American Medical Systems Inc., which makes the Monarc subfascial hammock that is placed using the transobturator approach. Dr. Ellerkmann reported that he has received consulting fees /honoraria as a preceptoring surgeon for Ethicon Inc., which makes the Gynecare tension-free vaginal tape used in the study.

Women with SUI, with or without pelvic organ prolapse (POP), were included in the trial if they were at least 21 years old and desired surgical correction of their SUI. Women were excluded if they had detrusor overactivity or previous sling surgery. Women with POP could undergo concurrent surgery for prolapse.

At baseline and at 1 year after surgery, the women completed the PISQ-12 (Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire-12). The PISQ-12 consists of 12 questions; scores can range from 0 to 48, with higher scores reflecting better sexual function. For 10 of the 12 items, responses include never, seldom, sometimes, usually, and always. For this analysis, responses were dichotomized as never/seldom or sometimes/usually/always. Responses to questions on orgasm intensity and frequency of sexual desire were similarly dichotomized.

Of the 170 women enrolled, 81% were sexually active at baseline. Of these, 88% completed the PISQ-12. Postoperatively, 162 patients were followed up with a 12-month visit. Of these, 126 were sexually active and 80% completed the PISQ-12 at follow up.

The women had a mean age of 52 years. Baseline demographics and clinical and incontinence severity data were similar for the two groups.

At baseline, sexual function as measured by the PISQ-12 total score was the same in both the tension-free vaginal tape and transobturator tape groups (34 points). Baseline sexual function was lower for those women with POP (29 points), compared with women without POP (35 points).

"An analysis of our 12-month postoperative PISQ-12 scores demonstrated a significant improvement in overall sexual function in both treatment arms with no difference between treatment groups," Dr. Ellerkmann said at the meeting, which was jointly sponsored by the American College of Surgeons. The mean change was an increase of 3 points. Overall, 69% noted an improvement in sexual function, 24% noted a worsening in sexual function, and the remainder noted no change.

In addition, women who had concurrent surgery for POP had greater increases in sexual function (mean increase, 4 points) than those who did not (mean increase, 1 point).

"There were no significant differences at 12 months following surgery in those questions related to behavioral/emotive aspects of sexual function," said Dr. Ellerkmann. Similarly, there were no significant differences between baseline and 1-year follow-up in orgasm intensity.


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Author:Wachter, Kerri
Publication:OB GYN News
Date:May 1, 2008
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