Urodynamic evaluation: can it prevent the need for surgical intervention in women with apparent pure stress urinary incontinence?

OBJECTIVES: To identify how many patients with symptoms of pure stress urinary incontinence (SUI) do not require any surgical treatment on the basis of urodynamics (UDS) and how many patients still do not require surgery 1 year after UDS. To assess the outcomes of these patients at 12-month follow-up. PATIENTS AND METHODS: Women with pure SUI received UDS and were prospectively divided into four groups, comprising women with: urodynamic stress incontinence (USI); detrusor overactivity (DO); USI + DO; and inconclusive UDS. Women with USI underwent a Tension Free Vaginal Tape (Obturator) (TVT-O) procedure (Gynecare; Ethicon Inc., Somerville, NJ, USA), whereas women with DO ±/- USI were recommended 24-week antimuscarinic therapy. Follow-up was scheduled at 3 and 12 months. To define subjective outcomes, all patients completed the International Consultation on Incontinence Questionnaire - short form, the Patient Global Impression - Improvement and the Urinary Distress Inventory. Patients were considered cured if they presented a negative stress test, a score reduction of at least 80% on the Urinary Distress Inventory and a response of 'much better' or 'very much better' on the Patient Global Impression - Improvement. RESULTS: Of the 263 women with pure SUI, 74.5% had a urodynamic diagnosis of USI, 10.6% had DO, 8% had USI + DO and 6.8% had inconclusive UDS. At 12-month follow-up, 165/181 (91.6%) women in group 1 were considered cured post-TVT-O; in the other groups, 33/67 (49.2%) patients were considered cured simply as a result of taking antimuscarinics; 13 of these 67 patients required TVT-O. CONCLUSIONS: UDS is able to show that several patients with symptoms of pure SUI present an underlying DO and do not require surgery, even 1 year after UDS. In these patients, antimuscarinic treatment appears to ensure a good rate of cure; thus, UDS could lead to the avoidance of several surgical procedures.

Perioperative allogenic blood transfusions and the risk of endometrial cancer recurrence.

PURPOSE: To evaluate the effect of perioperative blood transfusions on the risk of recurrence of endometrial cancer. METHODS: This study is a retrospective analysis of 358 consecutive patients, without a history of other tumors, who underwent surgery for endometrial cancer between January 2000 and April 2010. RESULTS: Women who did not need any transfusion (N = 331) and patients who received allogenic blood donations (N = 27) were compared in terms of risk of cancer recurrence. The surgical standard procedure included peritoneal washing for cytologic examination, total hysterectomy + bilateral adnexectomy (N = 358), and pelvic lymphadenectomy (N = 227). The two groups were homogeneous in term of age, BMI, previous abdominal surgery, type of intervention, operative time, nodal count, and hospital stay. The median (range) estimated blood loss was higher in the transfusion group, 400 mL (100-2,000 mL), than in the non-transfusion group, 150 mL (10-1,000 mL). Median (range) follow-up was 67.5 months (6-132.4 months). Blood transfusions were associated with a higher relapse rate (P = 0.0021). At multivariate analysis, administration of packed red blood cells remained independently associated with recurrence (OR 4.64; CI 95 % 1.45-14.9), as well as myometrial invasion ≥50 % (OR 2.88; CI 95 % 1.18-7.07) and stage >1 (OR 4.24; CI 95 % 1.75-10.3). CONCLUSIONS: The use of allogenic blood transfusions is associated with a higher risk of recurrence. We hypothesize that this could be due to a transitory perioperative immunodepression that promotes the spread of neoplastic cells.

Nerve-sparing minilaparoscopic versus conventional laparoscopic radical hysterectomy plus systematic pelvic lymphadenectomy in cervical cancer patients.

AIM: To present our preliminary experience with nerve-sparing minilaparoscopic radical hysterectomy plus pelvic lymphadenectomy for the surgical treatment of cervical cancer and to compare outcomes with those of the conventional laparoscopic approach. METHODS: Data of 87 consecutive women who underwent minimally invasive surgery for early and locally advanced stage cervical cancer were prospectively collected. Ten women who underwent laparoscopic surgery using a nerve-sparing technique performed through 3-mm ancillary ports were compared with the 77 patients who had standard laparoscopic surgery previously with 3 sovrapubic 5-mm trocars. RESULTS: Minilaparoscopic radical hysterectomy was successfully accomplished in every case with no conversion to standard laparoscopy or open surgery. Two (2.6%) conversions to open surgery occurred in the conventional laparoscopy group. Surgical characteristics (operative time, estimated blood loss, and length of stay) and complication rate were similar between the 2 groups. No differences in the amount of parametrial and vaginal tissue removed were observed. The number of lymph nodes retrieved through minilaparoscopy was higher than conventional laparoscopy (30 [range = 26-38] vs 22 [range = 8-49]; P = .002). However, no difference was observed when the analysis was restricted to the last 10 conventional procedures (30 [range = 26-38] vs 29 [range = 24-49]; P = .81). CONCLUSIONS: Our data show that minilaparoscopic radical hysterectomy with pelvic lymphadenectomy is a feasible procedure if performed by skilled surgeons.

Lymphoceles, lymphorrhea, and lymphedema after laparoscopic and open endometrial cancer staging.

PURPOSE: To evaluate the incidence of lymphoceles, lymphorrhea, and lymphedema after systematic pelvic lymphadenectomy in patients who underwent laparoscopic or open abdominal staging for endometrial cancer. METHODS: A total of 138 consecutive women who underwent systematic laparoscopic pelvic lymphadenectomy for endometrial cancer staging were compared to 123 historical control subjects staged via an open approach. Postoperative screening for lymphadenectomy-related complications by ultrasound was consistently performed. RESULTS: The incidence of perioperative complications was lower in cases than in control subjects. Overall, lymphoceles were diagnosed in 19 (15.4%) and 2 (1.4%) patients who had open and laparoscopic staging, respectively (odds ratio 12.42; 95% confidence interval 2.82-54.55; P < 0.0001). Symptomatic lymphoceles were more frequent after open staging than after laparoscopy (P = 0.028). Lymphorrhea occurred in 1 and 4 patients after laparoscopic and open surgery (P = 0.19). No difference in the incidence of lymphedema was observed. CONCLUSIONS: Our findings suggest that laparoscopic endometrial cancer staging is associated with a lower occurrence of both asymptomatic and symptomatic lymphoceles compared to open surgery.

Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial.

OBJECTIVE: We sought to compare transumbilical (TU) and transvaginal (TV) route for retrieval of surgical specimens at laparoscopy. STUDY DESIGN: Women scheduled for a laparoscopic resection of an adnexal mass were randomized to have their surgical specimen removed either through a posterior colpotomy (n = 34) or the umbilical port site (n = 32). Group allocation was concealed from patients and bedside clinicians. The primary outcome was postoperative incisional pain assessed by a 10-cm visual analog scale at 1, 3, and 24 hours after surgery. RESULTS: TV retrieval caused less postoperative pain than TU specimen extraction at each time point (visual analog scale score at 1 hour: 2.6 ± 2.9 vs 1.2 ± 2.0, P = .03; at 3 hours: 2.4 ± 2.0 vs 1.4 ± 2.0, P = .02; and at 24 hours: 1.1 ± 1.5 vs 0.5 ± 1.4, P = .02). A higher proportion of women in the TU group than in the TV group indicated the umbilicus as the most painful area at 1 and 3 hours postoperatively. Two months after surgery, the participants scored similarly as to their overall satisfaction, cosmetic outcome, and dyspareunia upon resumption of intercourse. CONCLUSION: A TV approach for specimen removal after laparoscopic resection of adnexal masses offers the advantage of less postoperative pain than TU retrieval.

A randomized trial of preinduction cervical ripening: dinoprostone vaginal insert versus double-balloon catheter.

OBJECTIVE: We sought to compare the efficacy of a double-balloon transcervical catheter to that of a prostaglandin (PG) vaginal insert among women undergoing labor induction. STUDY DESIGN: In all, 210 women with a Bishop score ≤6 were assigned randomly to cervical ripening with either a double-balloon device or a PGE2 sustained-release vaginal insert. Primary outcome was vaginal delivery within 24 hours. RESULTS: The proportion of women who achieved vaginal delivery in 24 hours was higher in the double-balloon group than in the PGE2 group (68.6% vs 49.5%; odds ratio, 2.22; 95% confidence interval, 1.26-3.91). There was no difference in cesarean delivery rates (23.8% vs 26.2%; odds ratio, 0.88; 95% confidence interval, 0.47-1.65). Oxytocin and epidural analgesia were administered more frequently when a double-balloon device was used. Uterine tachysystole or hypertonus occurred more frequently in the PGE2 arm (9.7% vs 0%, P = .0007). CONCLUSION: The use of a double-balloon catheter for cervical ripening is associated with a higher rate of vaginal birth within 24 hours compared with a PGE2 vaginal insert.

Vaginal cuff closure after minimally invasive hysterectomy: our experience and systematic review of the literature.

OBJECTIVE: To determine the incidence of vaginal cuff dehiscence after minimally invasive hysterectomy, we reported our series of total laparoscopic hysterectomies with transvaginal colporraphy. STUDY DESIGN: We then conducted a systematic search of PubMed to retrieve published series of laparoscopic and robotic hysterectomies, in which different techniques for vaginal cuff closure were used. RESULTS: In our study group, vaginal cuff dehiscence occurred in 2 of 665 (0.3%) patients. Our literature search identified 57 articles, for a total of 13,030 endoscopic hysterectomies. Ninety-one postoperative vaginal separations were reported (0.66%). The pooled incidence of vaginal dehiscence was lower for transvaginal cuff closure (0.18%) than for both laparoscopic (0.64%; odds ratio [OR], 0.28; 95% confidence interval [CI], 0.12-0.65) and robotic (1.64%; OR, 0.11; 95% CI, 0.04-0.26) colporraphy. Laparoscopic cuff closure was associated with a lower risk of dehiscence than robotic closure (OR, 0.38; 95% CI, 0.28-0.6). CONCLUSION: Current evidence indicates that transvaginal colporraphy after total laparoscopic hysterectomy is associated with a 3- and 9-fold reduction in risk of vaginal cuff dehiscence compared with laparoscopic and robotic suture, respectively.

Is transcervical Foley catheter actually slower than prostaglandins in ripening the cervix? A randomized study.

OBJECTIVE: The purpose of this study was to determine whether the maximum time for cervical ripening (from 24-12 hours) would influence the efficacy of a transcervical Foley catheter and to compare efficacy to that of a prostaglandin E(2) vaginal insert. STUDY DESIGN: Three hundred ninety-seven women were assigned randomly to (1) Foley catheter left in place for a maximum of 24 hours, (2) Foley catheter left in place for a maximum of 12 hours, or (3) prostaglandin E(2) controlled-release vaginal insert. Primary outcome was vaginal delivery within 24 hours. RESULTS: There were no differences in vaginal delivery rates. The proportion of women who achieved vaginal delivery in 24 hours was lower in the 24-hour Foley catheter group than in the other 2 groups (24-hour Foley catheter, 21.0%; 12-hour Foley catheter, 59.8%; vaginal prostaglandin E(2), 48.5%; P < .0001). CONCLUSION: Cutting the ripening time with a Foley catheter by one-half increases the proportion of women who deliver vaginally within 24 hours and yields efficacy similar to that of prostaglandin E(2) vaginal insert.

Female urinary incontinence at orgasm: a possible marker of a more severe form of detrusor overactivity. Can ultrasound measurement of bladder wall thickness explain it?

INTRODUCTION: Coital incontinence (CI) during orgasm is a form of urinary incontinence possibly because of detrusor overactivity (DO), as the underlying pathophysiological condition. Women with this symptom usually show a pharmacological lower cure rate than those with DO alone. The ultrasound measurement of the bladder wall thickness (BWT) allows an indirect evaluation of detrusor muscle thickness, giving a potential index of detrusor activity. AIM: We wanted to understand if CI at orgasm could be a marker of severity of DO by comparing BWT in women with both DO and CI at orgasm vs. women with DO alone. In addition we aimed to confirm if CI during orgasm is related to antimuscarinics treatment failure. METHODS: This is a prospective cohort study performed in two tertiary urogynecological referral departments, recruiting consecutive patients seeking treatment for symptomatic DO. MAIN OUTCOME MEASURES: All patients were thoroughly assessed including physical examination, urodynamic evaluation, and BWT measurement according to the International Continence Society/International Urogynecological Association and ICI recommendations. Solifenacine 5 mg once daily was then prescribed and follow-up was scheduled to evaluate treatment. Multiple logistic regression (MLR) was performed to identify risk factors for treatment failure. RESULTS: Between September 2007 and March 2010, 31 (22.6%) and 106 (77.4%) women with DO with and without CI at orgasm were enrolled. Women complaining of CI at orgasm had significantly higher BWT than the control group (5.8 ± 0.6 mm vs. 5.2 ± 1.2 mm [P=0.007]). In patients with CI at orgasm, the nonresponder rate to antimuscarinics was significantly higher than controls (P=0.01). After MLR, CI at orgasm was the only independent predictor decreasing antimuscarinics efficacy (odds ratio [OR] 3.16 [95% CI 1.22-8.18], P=0.02). CONCLUSIONS: Women with DO and CI at orgasm showed a significantly higher BWT values and worse cure rates than women with DO alone. CI at orgasm could be a marker of a more severe form of DO.

Use of an antispasmodic (rociverine) to shorten the length of labor: a randomized, placebo-controlled trial.

OBJECTIVE: To determine the effectiveness of rociverine, an antispasmodic drug, for reducing the duration of labor among nulliparous women managed according to a standard intrapartum protocol. DESIGN: Randomized controlled trial. SETTING: An academic tertiary care hospital. POPULATION: Nulliparae in spontaneous active labor, with cervical dilatation between 3 and 5 cm. METHODS: Participants were randomly assigned to receive either an intramuscular injection of 20mg rociverine (n=55) or the same volume of saline (n=56). MAIN OUTCOME MEASURE: Cervical dilatation rate (from administration of study drug to full dilatation). RESULTS: Laboring women who received rociverine had faster cervical dilatation than those assigned to placebo (2.43 ± 1.84 vs. 1.85 ± 1.38 cm/hour, p=0.03). The time interval from treatment administration to full cervical dilatation was shorter in the rociverine group than in the placebo group (220 ± 125 vs. 278 ± 129 min, p=0.04). No difference was found in any other obstetric outcome. No adverse effects have been recorded from rociverine administration. CONCLUSIONS: Intrapartum administration of rociverine to nulliparous women may help to reduce the duration of the first stage of labor in a context of uniform labor management.

Minilaparoscopic versus conventional laparoscopic hysterectomy: results of a randomized trial.

STUDY OBJECTIVE: To compare operative outcomes and postoperative pain of laparoscopic hysterectomy (LH) versus minilaparoscopic hysterectomy (MLH). DESIGN: Randomized controlled trial (Canadian Task Force Classification I). SETTING: Tertiary care center. PATIENTS: Seventy-six women scheduled to undergo a hysterectomy for a supposed benign gynecologic condition. INTERVENTIONS: Participants were randomly assigned to LH (n = 38) or MLH (n = 38). MLH was performed with use of 3-mm ports. Both patients and assessors of the postoperative outcomes were blinded to the size of port used, and patients' wounds were concealed by standard-size nontransparent dressings. MEASUREMENTS: Primary outcome was postoperative pain (both rest and incident on coughing and abdominal pain, as well as shoulder pain) by use of a 100-mm visual analogue scale. MAIN RESULTS: The two groups were similar in terms of operative outcomes. No intraoperative conversion from MLH to both LH and open surgery occurred. No significant difference in pain scores at 1, 3, 8, and 24 hours after surgery between groups was found. Rescue analgesic requirement was similar in the MLH and LH groups (21.1% vs 13.2%, p =.54). CONCLUSIONS: Ports can safely be reduced in size without a negative impact on the surgeon's ability to perform LH. MLH appears to have no advantage over LH in terms of postoperative pain.

Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial.

OBJECTIVE: To compare postoperative pain after laparoscopic and vaginal hysterectomy for benign disease. STUDY DESIGN: A prospective randomized trial was designed to compare laparoscopic hysterectomy and vaginal hysterectomy in patients with uterine volume

Female sexual function during pregnancy and after childbirth.

INTRODUCTION: Healthy sexual function during pregnancy and after childbirth is one of the cornerstones for couples to evolve from partners to parents. AIM: The aim of our review is to evaluate the available evidence and define present knowledge about female sexual function during pregnancy and after childbirth. METHODS: PubMed was searched for articles on sexual function during pregnancy and after childbirth, published from 1960 up to date. The most relevant articles have been reviewed and included. MAIN OUTCOME MEASURES: The main outcome is the review of the effect of pregnancy, delivery, and postpartum on female sexuality. RESULTS: A total of 48 articles which specifically addressed this topic were included. Sexual function was found to have a significant global decline during pregnancy, particularly in the third trimester and this persisted for 3-6 months following delivery. The lack of adequate information about sex in pregnancy and concerns about the possible adverse obstetric outcomes are the most relevant factors responsible for the avoidance of sexual activity during pregnancy. Breast-feeding, dyspareunia, and postpartum pelvic floor dysfunction were reported as possible causes for the delay in resuming sexual intercourses after childbirth. CONCLUSIONS: Couples should be informed about the decline of libido, desire and orgasm, commonly encountered during pregnancy, particularly in the last trimester, and puerperium which may lead to reduction in sexual intercourse frequency.

The impact of the loop electrosurgical excisional procedure for cervical intraepithelial lesions on female sexual function.

INTRODUCTION: Very limited knowledge exists concerning the impact of Loop Electrosurgical Excisional Procedure (LEEP) on female sexual function in women with cervical intraepithelial neoplasia AIM: To investigate sexual function in women who underwent LEEP for the treatment of cervical intraepithelial lesions, using a validated questionnaire (Female Sexual Function Index [FSFI]). MAIN OUTCOME MEASURES: FSFI questionnaire on six domains of female sexuality (desire, arousal, lubrication, orgasm, satisfaction, and pain). METHODS: Consecutive sexually active women, who underwent LEEP for the treatment of cervical intraepithelial neoplasia were enrolled in this study. All women were asked to complete a copy of FSFI questionnaire, at the time of LEEP and after 6 months. We finally compared the results of the pre-LEEP questionnaire and the post-LEEP questionnaire for each patient. RESULTS: A total of 67 sexually active women undergoing LEEP for the treatment of cervical intraepithelial lesions were enrolled. Nine of these patients (13.4%) completed only the questionnaire regarding their sexual function before LEEP; thus we did not include them for final analysis. In our study population, data showed a sexual function overall unchanged after LEEP; only the variable "desire" (sexual interest) became significantly worse (P = 0.02). CONCLUSIONS: LEEP for the treatment of cervical intraepithelial lesions doesn't affect women's sexuality, when compared with sexual function before surgery. In our study, all FSFI sexual function domains but desire, did not show significant change after LEEP.

Incorporating laparoscopy in the practice of a gynecologic oncology service: actual impact beyond clinical trials data.

BACKGROUND: Feasibility and safety of laparoscopic management of gynecologic cancers have been established by numerous clinical trials. However, the degree to which such results are achievable outside the context of formal research programs and the actual extent of laparoscopy uptake since its introduction are unclear. Purpose of this study was to examine the impact upon operative and cancer outcomes of the incorporation of laparoscopy into the surgical practice of our gynecologic oncology service. METHODS: Data from 383 consecutive women undergoing surgery for the treatment of an apparently early-stage gynecologic cancer between 2000 and 2008 were analyzed. Integration of minimally access surgery for the treatment of invasive malignancies began with borderline ovarian tumors in 2001 and proceeded sequentially to include endometrial, ovarian, and cervical cancer patients. RESULTS: The annual proportion of laparoscopic cases has increased significantly over the study period from 7.7% in 2001 to 90.9% in 2008 (P < 0.0001 for trend). A temporal trend toward reduction in estimated blood loss was observed in both endometrial cancer and cervical cancer patients (P < 0.0001). There was a significant decrease in the percentage of patients requiring blood transfusions [18 (17.1%) during the period 2000-2002, 19 (13.6%) during 2003-2005, and 8 (5.8%) during 2006-2008; P = 0.005 for trend]. Length of hospital stay has decreased significantly over time for all disease sites (P < 0.0001 for endometrial and cervical cancer; P = 0.02 for ovarian cancer). No difference was found in median operative time, number of lymph nodes harvested, complication rates, 1- and 2-year disease-free survival, and overall survival when data of subsequent time periods were compared. CONCLUSIONS: Substantial utilization of laparoscopy in the existing practice of a gynecologic oncology service provided benefits to patients without detrimental effects on clinical outcomes. The relatively short follow-up time of laparoscopic cases disallows firm conclusions on long-term survival.

Microlaparoscopy: a further development of minimally invasive surgery for endometrial cancer staging -- initial experience.

OBJECTIVES: To present our initial experience with micro-laparoscopy in the surgical treatment of endometrial cancer and to compare its outcomes with those of conventional laparoscopic approach. METHODS: Consecutive patients undergoing surgical staging of endometrial cancer using exclusively 3-mm working ports and a 3- or 5-mm laparoscope at the umbilicus (microlaparoscopy group; N=23) were compared with historical controls selected from consecutive women who have had staging with conventional laparoscopy (N=80). RESULTS: No difference was found in demographics and preoperative variables between the two groups. Conversion from microlaparoscopy to a conventional laparoscopic technique occurred in two cases (9.7%), while there was no conversion to open surgical staging in either group. There were no significant differences between the microlaparoscopy group and the control group with regard to estimated blood loss [100 (10-400) vs. 100 (10-400), P=0.09], number of pelvic lymph nodes (19.2+/-7.4 vs. 18. 6+/-7.2, P=0.79), and complication rate (intraoperative: 0% vs. 2.5%, P=1.0; postoperative: 8.7% vs. 13.7%, P=0.73). Operative time was similar between groups when analysis was restricted to the last 20 conventional procedures performed period prior to beginning of the microlaparoscopy trial [155 (110-300) vs. 160 (115-295), P=0.17]. The median length of hospital stay was 2 (1-10) days for women undergoing microlaparoscopic procedures compared to 3 (1-15) days for those undergoing conventional laparoscopy (P=0.001). CONCLUSIONS: These preliminary results suggest that microlaparoscopy is a safe and adequate surgical option for endometrial cancer staging, with the potential to further decrease invasiveness of the conventional laparoscopic approach.

First-trimester maternal serum screening and the risk for fetal distress during labor.

OBJECTIVE: The purpose of this study was to assess whether low pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester are related to the risk of emergency cesarean section delivery (CS) for fetal distress during labor and fetal intrapartum acidemia. STUDY DESIGN: We prospectively studied patients who requested first-trimester biochemical screening for Down syndrome. RESULTS: Among the 1037 women who were enrolled, 152 women (14.7%) had a low first-trimester PAPP-A value, and 855 women (85.3%) had a normal first-trimester PAPP-A value. Excluding elective CS, 19 of 117 women (16.2%) with low PAPP-A values vs 59 of 749 women (7.9%) with normal PAPP-A values underwent CS for concerning fetal status during labor (P = .003; odds ratio, 2.27; 95% confidence interval, 1.30-3.97). This difference remained significant after correction for possible confounders (hypertension, preterm delivery, small for gestational age, labor induction). Among these 78 women, umbilical artery pH was significantly lower in fetuses from mothers with low vs normal PAPP-A values (pH = 7.19 [range, 6.95-7.39] vs pH = 7.26 [range, 7.02-7.39]; P = .022). CONCLUSION: Low PAPP-A levels at first-trimester screening are associated independently with higher rates of emergency CS for nonreassuring fetal status during labor and lower pH.

Female urinary incontinence during intercourse: a review on an understudied problem for women's sexuality.

INTRODUCTION: Coital urinary incontinence is a frequently underreported symptom, with a relevant impact on women's sexuality and quality of life. AIM: This article will review the available evidence on incidence, pathophysiology, and treatment of coital urinary incontinence with the attempt to present the current state of the art. METHODS: PubMed was searched for reports about coital urinary incontinence that were published from 1970 to 2008, and the most relevant articles were reviewed. MAIN OUTCOME MEASURES: Review on epidemiology, pathophysiology, diagnosis, and treatment of coital incontinence. RESULTS: The incidence of coital incontinence in incontinent women has been reported to range between 10% and 27%. At present, some evidence suggests an association between urinary leakage at penetration and urodynamic stress (USI) incontinence as well as urinary leakage during orgasm and detrusor overactivity (DO). When treatment for these conditions are based upon urodynamic findings, pelvic floor muscle training, surgery, and pharmacotherapy show satisfactory cure rates. CONCLUSIONS: Coital urinary incontinence deserves much more attention in clinical practice: women should be specifically interviewed for this disturbance because it has a very negative impact on their sexuality. If a reliable urodynamic diagnosis is made, coital urinary incontinence at penetration can be cured in more than 80% of cases by surgery in the presence of USI. The form of coital incontinence during orgasm is curable by antimuscarinic treatment in about 60% of cases when associated with DO.

The impact of the mid-urethral slings for the treatment of stress urinary incontinence on female sexuality.

INTRODUCTION: No available review has been specifically designed to analyze the relationship between mid-urethral slings for stress urinary incontinence (SUI) and female sexual function. AIM: The aim of our review has been to go through the available evidence and define the present state of the art about the effects of this specific type of surgery for SUI on female sexuality. METHODS: PubMed was searched for reports about the impact of mid-urethral slings on female sexual function that were published from 1995 to 2008, and the most relevant papers were reviewed. MAIN OUTCOME MEASURES: Review on the effect of mid-urethral slings on sexuality. RESULTS: A total of 14 papers including 904 women have been published about the relationship between mid-urethral slings and female sexual function. The main mechanism accounting for improved sexuality is the cure of coital incontinence, while the most common symptom related to worsened sexual life is dyspareunia. CONCLUSIONS: In the majority of cases, women undergoing mid-urethral sling procedures for SUI report that their sexual function is improved or unchanged by this type of surgery, although a not negligible risk of developing dyspareunia (<15%) exists. There are no sufficient data to draw definitive conclusions about possible differences between retropubic vs. transobturator procedures.

Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy?

INTRODUCTION: Surgical treatment for cervical cancer is associated with a high rate of late postoperative complications, and in particular with sexual dysfunction. AIM: To evaluate sexual function in women who underwent radical hysterectomy (RH), in comparison with a control group of healthy women, using a validated questionnaire (Female Sexual Function Index [FSFI]). Then we tried to evaluate the possible differences between laparoscopic RH and abdominal RH in terms of their impact on sexuality. METHODS: Consecutive sexually active women, who underwent RH for the treatment of early-stage cervical cancer between 2003 and 2007, were enrolled in this study (cases) and divided into two groups, according to the surgical approach. All women were administered the FSFI. The results of this questionnaire were compared between patients who underwent laparoscopic RH (LPS group) vs. women who underwent laparotomic RH (LPT group). The cases of RH were also compared with a control group of healthy women, who were referred to our outpatient clinic for a routine gynecologic evaluation. MAIN OUTCOME MEASURES: FSFI questionnaire on six domains of female sexuality (desire, arousal, lubrication, orgasm, satisfaction, pain). RESULTS: A total of 38 patients were included. We also enrolled 35 women as healthy controls. FSFI score was significantly higher in the healthy controls vs. the cases of RH. In the LPS group, the total score and all the domains of the FSFI were lower in comparison with the healthy controls, whereas three of the six domains (arousal, lubrication, orgasm) and the total score of FSFI were lower in the LPT group if compared with the controls. There were no significant differences between LPS and LPT group. CONCLUSIONS: RH worsens sexual function, regardless of the type of surgical approach. In our experience, laparoscopy did not show any benefit on women's sexuality over the abdominal surgery for cervical cancer.