Sling Surgery

Content Written By: Rachel N Pauls, MD, FACOG

Suburethral sling procedures are a very common treatment for stress urinary incontinence (incontinence with sneezing, coughing, lifting). The latest generation of slings involve placement of synthetic mesh at the mid-urethra via a minimally invasive approach. These procedures are fast becoming the treatment of choice for stress incontinence in women due to their minimal risk and morbidity, as well as excellent success rates. While several modifications of these sling surgeries exist, the available information on each technique with respect to sexual function is limited. On that basis, in this document all sling procedures will be discussed together.

Women with stress urinary incontinence often suffer from sexual function alterations due to loss of spontaneity, irritation of the vulva, depression, and low body image. Surgical treatment with a suburethral sling is extremely successful at curing stress incontinence; this may result in improvements in sexual function. However, minor deteriorations have also been noted. Potential reasons for negative effects include disruption of the nerve supply to the female sexual organs, alteration in the vaginal axis or vaginal girth, scar tissue formation at incision lines, and complications related to the mesh itself, such as extrusion, partner discomfort, vaginal discharge and vaginal bleeding.

The majority of studies addressing this issue show marked improvements in sexual function as symptoms of urinary incontinence lessen. However, a few authors report deteriorations in women’s orgasm and satisfaction, as well as increased pain after the surgery. While these subjects are the minority in all studies, it still must be noted. Providers should be aware of the potential for alterations and counsel women about risks and expectations prior to any surgical intervention. Women who experience problems following surgery must have these addressed early in the postoperative period in order to alleviate any long-term impact on their quality of life.


References:

1. Jha S, Radley S, Farkas A, Jones G. The impact of TVT on sexual function. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20(2):165-169.

2. Brubaker L, Chiang S, Zyczynski H, Norton P, Kalinoski DL, Stoddard A, et al. The impact of stress incontinence surgery on female sexual function. Am J Obstet Gynecol 2009; 200(5):562-567.

3. Cayan F, Dilek S, Akbay E, Cayan S. Sexual function after surgery for stress urinary incontinence: vaginal sling versus Burch colposuspension. Arch Gynecol Obstet 2008; 277(1):31-36.

4. Ghezzi F, Serati M, Cromi A, Uccella S, Triacca P, Bolis P. Impact of tension-free vaginal tape on sexual function: results of a prospective study. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17(1):54-59.

5. Jha, S, Moran P, Greenham H, Ford C. Sexual function following surgery for urodynamic stress incontinence. Int Urogynecol J Pelvic 2007; 18(8):845-850.

6. Mazouni C, Karsenty G, Bretelle F, Bladou F, Gamerre M, Serment G. Urinary complications and sexual function after the tension-free vaginal tape procedure. Acta Obstet Gynecol Scand 2004; 83(10):955-961.

7. Pace G, Vicentini C. Female sexual function evaluation of the tension-free vaginal tape (TVT) and transobturator suburethral tape (TOT) incontinence surgery: results of a prospective study. J Sex Med 2008;5(2):387-393.

8. Yeni E, Unal D, Verit A, Kafali H, Ciftci H, Gulum M. The effect of tension-free vaginal tape (TVT) procedure on sexual function in women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14(6):390-394.

9. Pauls RN, Karram MM. Sexual function following anti-incontinence surgery. Minerva Urol Nefrol 2008; 60(2):113-122.

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