Female sexual function and quality of life after pelvic floor surgery: a prospective observational study.

INTRODUCTION AND HYPOTHESIS: Knowledge about the impact of pelvic floor surgery on sexual function is limited and inconsistent. A prospective study assessed the impact of surgery for prolapse (POP) or stress urinary incontinence (SUI) on sexual function and determined the biopsychosocial predictors for changes in sexual function after surgery. MATERIALS AND METHODS: Sexually active women scheduled for correction of POP and/or SUI were recruited over a 6-month period. Consenting participants were asked to complete the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to evaluate sexual function. The King's Health Questionnaire and Prolapse Quality-of-Life Questionnaire were used to assess UI and POP symptoms and their impact on quality of life (QoL), respectively. Women were reviewed over a period of 1 year post-surgery. RESULTS: Ninety-one patients were followed up over 1 year. After stratification into only or both SUI and POP surgery, global sexual function improved significantly in each group (p < 0.001). The improvement in the overall QoL score after pelvic surgery showed a significant correlation with the improvement in global sexual function (SUI group: r = - 0.38, p < 0.01; POP group: r = - 0.44, p < 0.05). For women undergoing SUI surgery, only educational level and prior hysterectomy had a significant association with improved sexual function. For women undergoing POP surgery with or without SUI surgical repair, no sociodemographic characteristics were preditive of improvement of sexual function. CONCLUSIONS: Significantly improved sexual function was observed 1 year after pelvic floor surgery, and the improvement was predicted by other social and physical factors in addition to normal functional anatomy.

[Minimally invasive surgery in women with recurrent stress urinary incontinence]. / Cirurgia minimamente invasiva na mulher com incontinência urinária de esforço.

OBJECTIVES: Evaluate the efficacy and safety of minimally invasive surgical techniques as second procedure in recurrent stress urinary incontinence (SUI). STUDY DESIGN: We retrospectively analyzed data on patients submitted to this type of surgery after previous surgery failure, since September 2002 to December 2006. Several parameters were evaluated: women's age, symptoms, previous surgery, urodynamics results, procedure technique, complications at short (two months) and medium term (one year) results. RESULTS: Of the 73 analyzed cases, 57 patients had been submitted previously to classic surgery and 16 to minimally invasive surgery. In surgery for recurrent SUI using minimally invasive techniques eight complications were registered (five vaginal perforations, two bladder lacerations and one femoral vein laceration); post-op complications occurred in 13 cases (three urinary retentions, two urinary tract infections, one anaemia and seven vaginal sling erosions). Short-term cure, improvement and failure rates were 69.9%, 28.8% and 1.4%, respectively. At medium term, these rates were of 54.8%, 41.1% and 4.1%, respectively. CONCLUSIONS: Minimally invasive surgery for recurrent SUI is a valid option after previous surgery failure, given the low morbidity and reduced failure rate at short and medium term.

Perineal cellulitis as a late complication of trans-obturator sub-urethral tape, Obtape.

The authors report the case of a perineal cellulitis occurring 10 months after the surgical treatment for stress urinary incontinence with a trans-obturator sub-urethral tape, Obtape (Porgès). This is a very rare complication related to a prolonged intra-vaginal tape exposure and infection that occurs after vaginal erosion, possibly due to tape rejection. This complication has been described with Obtape and with Uratape. The former lacks a sub-urethral silicone coated section that distinguishes it from Uratape. We still do not know much about the constituents of these types of sub-urethral tapes specially about their human tolerance, and we should therefore look at them carefully.