Hypothesis / aims of study
Stress urinary incontinence (SUI) affects approximately 25–50% of women, impairing quality of life and aspects of sexual function.(1) The single-incision mid-urethral sling (SIMS) is a less invasive alternative for treating SUI, providing a faster procedure and fewer complications than conventional slings.(2) The use of local anesthesia contributes to improved patient recovery and minimises complications during the perioperative period.(3) Although short-term outcomes of SIMS are well documented, data on its long-term impact on sexual function remain limited. This study evaluates changes in sexual life following the placement of SIMS under local anesthesia, examined over a two-year follow-up. Understanding these effects is essential, as postoperative dyspareunia, altered vaginal sensation, and psychological factors may impact patient satisfaction and the success of treatment. By addressing this gap, our findings enhance the approach to managing SUI while preserving sexual well-being.
Study design, materials and methods
From December 2019 to January 2025, a prospective cohort study was implemented in a tertiary academic center's urogynecologic unit. All patients who were consecutively administered SIMS for moderate or severe SUI were included. The initial examination included medical history, POP-Q staging, urodynamics, cough stress test (1-3-5), and pelvic floor ultrasound. Patients with concurrent pelvic organ prolapse, prior incontinence surgery, or lack of sexual activity were excluded. The continence state and sexual life of patients were assessed utilising standardised questionnaires (ICIQ-SF, ICIQ-FLUTS, ICIQ-VS, FSFI, PISQ-12). Statistics were performed using Microsoft EXCEL® and JASP (Version 0.19.1).
Results
A total of 103 Caucasian sexually active women consecutively underwent SIMS for moderate (25/103, 24.3%) or severe (75/103, 72.8%) SUI and returned for a 24-month follow-up; The demographics are presented in Table 1. At 24-month follow-up, the stress test was negative in 94.2% (97/103) of the participants, 93.2% (96/103) had PGI-I scores 1 and 2, and 87.4% (90/103) had PGI-S score 1. The mean ICIQ-SF and ICIQ-FLUTS scores decreased from 14.38±2.47 and 19.15±6.17 preoperatively to 2.14±3.14 and 6.58±5.63. There was one incidence of mesh erosion (Table 1).
Evaluation of sexual function before surgery and 24 months post-operative indicated a statistically significant improvement across every domain of FSFI, with the exception of pain. The mean total FSFI score showed a statistically significant improvement, increasing from 17.05±9.57 to 20.43±9.71. All the subgroups of patients enjoyed improved FSFI rates, but only the group of pre-menopausal incontinent women had normal FSFI score (27.37±7.94) at follow-up (Table 2).
The mean total PISQ-12 score improved significantly from 29.47 ± 7.36 to 35.26 ± 5.00. All the subgroups of patients had significantly improved PISQ-12 scores at follow-up (Table 2).
Interpretation of results
Examining the impact of urinary incontinence using the FSFI and PISQ-12 indicated diminished sexual function in women with SUI. The treatment of urinary incontinence with SIMS leads not only to a significant improvement in continence but also in sexual function. A proper threshold for separating between women with and without sexual dysfunction may be an overall FSFI score of less than 26. The only subgroup of patients found with FSFI>26 was the pre-menopausal women. The rest of the patients showed marked improvements in FSFI score, but not a return to normal values, indicating that sexual life is primarily a multi-factorial area, and poor scores in incontinence patients may be related to non-incontinence conditions.