Sexual Function After Prolapse Repair and Retropubic Versus Single-incision Sling

IMPORTANCE: Studies have shown that sexual function improves after surgical correction for stress urinary incontinence and pelvic organ prolapse. Current data suggest no significant difference in sexual function between transobturator and retropubic slings. However, there have been conflicting data regarding the newer, single-incision slings. OBJECTIVE: The objective was to evaluate sexual function after placement of single-incision versus retropubic slings for management of stress incontinence among patients undergoing concomitant native tissue vaginal repair. STUDY DESIGN: We performed a secondary analysis of data collected through a multicenter, prospective randomized trial of patients with ≥ stage 2 prolapse and objectively confirmed stress urinary incontinence. Participants were randomized to concomitant single-incision sling with suprapubic sham incisions, or retropubic sling at the time of native tissue vaginal repair. All participants completed baseline and 12-month Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). The primary outcome was sexual function, as measured by change in summary PISQ-IR score. RESULTS: Of 227 randomized participants who completed both baseline and 12-month questionnaires, 72 reported continued sexual activity. Of these, 36 (50%) were randomized to a single-incision and 36 (50%) to a retropubic sling. Sexual function was improved from baseline to follow-up (3.3-3.7 for single-incision, P<0.01; 3.2-3.8 for retropubic, P<0.01), and there was no difference between groups (P=0.21). CONCLUSION: For sexually active patients undergoing native tissue vaginal repair and concurrent sling placement for stress incontinence, sexual function scores overall improved in patients randomized to both single-incision and retropubic slings and were not different between groups.