Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence,risk factors and impact on quality of life in Taiwanese women: An observational cohort study

Objective

The study was to investigate the prevalence and risk factors of stress urinary incontinence (SUI) and its impact on the quality of life during pregnancy and 12 months after delivery.

Estudio prospectivo sobre la efectividad de una minibanda suburetral en el tratamiento de la incontinencia urinaria de esfuerzo

Objectives

To assess the efficacy of the tension-free vaginal tape mini-sling (TVT-S) to treat stress urinary incontinence (SUI) in women.

Material and method

We performed a prospective study of 170 patients who underwent TVT-S insertion and who were followed-up for at least 24 months. Both the objective and subjective cure rate were evaluated using clinical examination and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).

Results

The final number of assessed women was 137. The objective cure rate was 84% and the subjective cure rate was 91.2%. There were 7 complications during the surgery and 5 cases of mesh exposure (3.6%) during the follow-up period.

Conclusions

In our experience, the TVT-S cure rate for SUI is acceptable but is lower than the published cure rate for tension-free transvaginal tape (TVT) and tension-free transvaginal tape obturator (TVT-O).     

Patient goals after incontinence procedures: does the single-incision sling satisfy them?

Objective

This study was undertaken to describe short-term postoperative achievement of subjective preoperative goals for single-incision MiniArc slings, in comparison with tension-free vaginal tape (TVT).

Method

Patients submitted to mid-urethral sling (TVT and MiniArc) procedures for stress urinary incontinence (SUI) in two centers were included in this prospective study. Before surgery, the patients completed a preoperative open-ended questionnaire, in which they described their personal outcomes goals for SUI surgery and the degree of severity of their symptoms. At the first postoperative check, they were asked to assess the degree to which their goals had been met and the degree of postoperative incontinence symptoms; their grade of satisfaction was evaluated with IIQ-7, UDI-6 and a 0–10 visual analog scale.

Results

One hundred and eight patients (TVT n = 51, MiniArc n = 57) were included in this study. Incontinence symptom relief and improvement of quality of life were the most commonly described preoperative goals. Six to eight weeks after surgery, 47 patients (92.1%) after TVT and 53 (92.9%) women after single-incision slings were objectively cured (P = 1). After surgery, more than 90% of the patients in both groups achieved their preoperative goals. Symptom scores improved significantly and were comparable in both groups.

Conclusion

Our results show that self-reported achievement of preoperative goals of patients submitted to single-incision slings are comparable at the first follow-up with patients who have undergone the classic mid-urethral sling.     

Continence outcomes following partial excision of vaginal mesh exposure after mid-urethral tape insertion

Objective

To assess the incidence of recurrent stress urinary incontinence (SUI) following vaginal excision of exposed mid-urethral tape (MUT).

Study design

This was a retrospective observational study in a tertiary urogynaecology unit of an inner city teaching hospital. The population consisted of 41 consecutive women seen with a vaginal mesh exposure following MUT insertion between 2000 and 2009, which failed to resolve with conservative measures. The primary outcome measure was the presence of symptoms of stress urinary incontinence following surgical excision of exposed mesh.

Results

The incidence of recurrent SUI following tape excision was 34.1%. Type of mid-urethral tape, menopausal status, and the time interval between tape insertion and excision were not found to be significantly associated with the risk of recurrent SUI.

Conclusions

Over a third of women experience recurrent SUI after surgical management of vaginal mesh exposure following MUT insertion. Risk factors may be more comprehensively studied using prospectively collected cohorts.     

Initial experience with a short,tension-free vaginal tape (the tension-free vaginal tape secur system)

Objective

The aim of this study is to present our first experience with a novel modification of the tension-free sling idea and to evaluate the safety and efficacy of this new procedure for the treatment of stress urinary incontinence in women.

Study design

Eighty-five women with previously untreated stress urinary incontinence were recruited to participate in a clinical study. The efficacy of this surgical procedure was evaluated perioperatively and 3 months (±1 week) after operation—objectively by cough test and subjectively by the questionnaires Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire and the International Consultation on Incontinence Questionnaire-Short Form. All data were processed and statistical analyses performed in statistical environment R, version 2.5.1.

Results

From our results we conclude that there were no perioperative complications, objectively 62% of these patients were completely dry and 25% of patients improved. We observed a higher proportion of vaginal wall erosion (7/85) and urgency de novo (5/85) in the learning period group with respect to the routine period group.

Conclusions

Our first experience with the tension-free vaginal tape secur system procedure is that it has a low percentage of perioperative complications. The learning curve has to be taken in account with reference to postoperative complications.     

Optimal primary minimally invasive treatment for patients with stress urinary incontinence and symptomatic pelvic organ prolapse: Tension free slings with colporrhaphy,or Prolift with the tension free midurethral sling?

Objective

Comparison of procedures in patients with concomitant stress urinary incontinence (SUI) and pelvic organ prolapse (POP) was performed. Tension free vaginal tape (TVT) or transobturator tape (TOT) with colporrhaphy was compared with fixed mesh (Prolift™) applied with a tension free suburethral sling.

Study design

A total of 76 women with both SUI and POP were evaluated. TVT or TOT with colporrhaphy was performed in 39 patients and Prolift™ with the midurethral sling in 37 patients. Anatomy, symptoms and quality of life (QOL) were evaluated prior to, and at 1, 6 and 12 months after surgery.

Results

Continence was achieved in both groups equally (p = 0.57). The better anatomic outcome regarding the correction of POP was in the Prolift™ group but with a higher rate of additional procedures and complications. QOL was better in patients with grade III–IV POP corrected with Prolift™ (p = 0.05) and equal in both groups with grade I–II POP during the follow-up. Impairment of sexual life was present in both groups before surgery. After surgery, there was no improvement in sexual life regardless of correction of both anatomy and incontinence.

Conclusion

Both procedures are effective and safe. TVT or TOT performed with colporrhaphy looks a better primary choice for grade II POP and SUI. Results for grade III–IV POP and SUI are better with the Prolift™ with the sling. Sexual life could not be improved effectively with these types of surgery.     

Factors influencing outcome following the tension-free vaginal tape (TVT)

Objectives

To evaluate factors influencing the outcome with tension-free vaginal tape (TVT).

Study design

A prospective questionnaire survey of 100 women undergoing TVT between January 2006 and May 2007 for urodynamic stress incontinence. All women were assessed pre-operatively and 3 months post-operatively using a validated electronic pelvic floor symptoms assessment questionnaire (ePAQ). Using linear regression, the influence of age, severity of stress incontinence and pre-existing lower urinary tract symptoms (LUTS) were assessed on symptomatic improvement of stress urinary incontinence and on quality of life (QoL).

Results

Women with more severe symptoms preoperatively had a significantly greater improvement in stress incontinence symptoms (p < 0.001) and quality of life (p = 0.016). Age and pre-existing LUTS were not associated with adverse outcomes with surgery in terms of improvement in stress incontinence or quality of life.

Conclusions

Women with more severe stress urinary incontinence may expect greater improvement, both in their stress incontinence and their health-related quality of life (HRQoL) following a TVT. Age and coexisting lower urinary tract symptoms do not impact significantly on TVT outcomes in terms of the reduction in stress incontinence or improvement in HRQoL.     

Impact of HTLV-I in quality of life and urogynecologic parameters of women with urinary incontinence

Objective

To assess the impact of urinary incontinence in quality of life, epidemiological data, symptoms, findings of gynecological/neurological examination and urodynamic of HTLV-I seropositive women compared with HTLV-I negative women.

Study design

43 incontinent women were divided in two groups: 24 seropositives and 19 seronegatives for HTLV-I. We used King's Health Questionnaire (KHQ), standardized recorded data and urodynamics. Data were compared using Mann–Whitney test or Chi-squared test.

Results

Quality of life was significantly worse in seropositive incontinent women in the following parameters: general perception of health, impact of incontinence, limitation of daily life activities, social relations, sleep and disposition. Also, the following gynecological/neurological symptoms were more prevalent in seropositives: pain on vesical filling, dyspareunia, parestesis in inferior members, increased perineal sensitivity, pain in vaginal palpation, increased vaginal tonus, gait alteration, increased patellar reflex, Babinski reflex positive and increased tonus in inferior members.

Conclusion

Poor quality of life and physical abnormalities were identified in incontinent HTLV-I seropositive women when compared with incontinent HTLV-I seronegative women.     

Factors involved in the persistence of stress urinary incontinence from pregnancy to 2 years post partum

Objective

To identify factors involved in the persistence of stress urinary incontinence (SUI) from pregnancy to 2 years post partum.

Method

In a longitudinal study at Donostia Hospital, San Sebastián, Spain, 458 primigravid women were recruited from April to October 2007. SUI was diagnosed via the 2002 International Continence Society definition. Severity was assessed via the Incontinence Severity Index, and impact on quality of life via the International Consultation on Incontinence Questionnaire. Means (Student t test and analysis of variance) and percentages (χ² and Fisher exact tests) were compared, and multiple logistic regression analysis was performed with variables that were significant or close to significant in a univariate analysis (P < 0.2).

Results

Among 272 eligible women attending follow-up at 2 years post partum, 26 (9.5%) women reported persistent SUI since pregnancy. Incontinence severity was slight or moderate in most cases and the impact on quality of life was low. A higher body mass index (BMI) in pregnant women at term was the only factor found to be associated with persistent SUI (odds ratio 1.19; 95% confidence interval 1.08–1.32).

Conclusion

Higher BMI in pregnant women at term was an independent risk factor for the persistence of SUI from pregnancy to 2 years post partum.     

Coital Incontinence in Women With Urinary Incontinence: An International Study

Introduction

Coital urinary incontinence (CUI) is not much explored during clinical history, and this could lead to an underestimation of the problem.

A prospective study of pelvic floor dysfunctions related to delivery

Objective

To estimate the prevalence and impact on quality of life of urinary incontinence (UI) and anal incontinence (AI) three months after first delivery; to identify risk factors involved in UI or AI; to evaluate possible changes in sexual behaviour and anatomical modifications of pelvic floor after childbirth.

Study design

A multicenter prospective study, in six Italian Ob/Gyn departments, of nulliparous women who delivered at term (37-42 weeks of gestation) between April and September 2005. A structured questionnaire investigated several maternal and obstetric variables. UI and AI were assessed by administration of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and according to Wexner's Continence Grading Scale, at 2-3 days post-partum and at 3 months after delivery. Changes in sexual behaviour, and pelvic floor condition after delivery, were also recorded. Statistical analysis included comparison of means (Mann-Whitney or Student's t-test) and proportions (Chi-square test). Multiple logistic regression analysis was performed including variables that were significant in univariate comparisons.

Results

Of 960 enrolled women, 744 were evaluated 3 months after delivery and included in final analysis. The prevalences of UI and AI at that time were 21.6% and 16.3%, respectively. Onset of incontinence during pregnancy was an independent predictor for persistent UI (Odds Ratio (OR) 4.6, Confidence Interval (CI) 3.1-6.8, p < 0.001) and AI (OR 3.6, CI 2.2-6.1, p < 0.001). Family history of urinary or anal incontinence were respectively associated with UI (OR 2.6, CI 1.6-4.0, p < 0.001) and AI (OR 2.4, CI 1.4-4.0, p < 0.001) 3 months after delivery. Among obstetric factors, vaginal delivery was a strong risk factor for UI (OR 3.3, CI 2.0-5.3, p < 0.001). The sexual score improved 3 months after delivery in 72.4% of women. Urogynaecological evaluation showed a significant association between grade 1-2 anterior prolapse, urethral hypermobility and UI.

Conclusion

New onset of UI or AI during pregnancy, positive family history and vaginal delivery are independent risk factors for the persistence of symptoms of UI and AI in the early postpartum period. Adequate counselling and the implementation of targeted strategies to prevent or early identify these conditions are therefore mandatory to improve the patient's quality of life.     

De novo stress urinary incontinence after vaginal repair for pelvic organ prolapse: one-year follow-up

Objective

A few studies have reported a wide range (2–43%) in incidence of de novo stress urinary incontinence (SUI) following surgical repair of pelvic organ prolapse (POP) in previously continent women. The aim of this study was to re-examine this incidence up to one year following vaginal repair of prolapse.

Study design

Retrospective review of a cohort of women who underwent reconstructive vaginal repair of POP without a concomitant anti-incontinence procedure between 2003 and 2007 at two tertiary referral centers. Women were considered eligible if they were stress continent by symptoms and objective assessment (including urodynamics testing) prior to surgical repair. All women who had had any anti-incontinence procedure previously were excluded. The endpoint was subjective SUI that prompted the patient to undergo any treatment within one year from their prolapse surgery.

Results

64 women, with a mean age of 61 (±11) years, were eligible for the study: 26 (41%) had preoperative symptoms of overactive bladder. Fifty-four patients were available for analysis at the one-year visit. Seven women (13.5%) had symptoms of SUI but only one (2%) was found to have SUI objectively. Another patient underwent anti-incontinence surgery following her prolapse surgery.

Conclusion

The incidence of de novo SUI requiring treatment in previously continent women who underwent vaginal repairs for POP without concomitant anti-incontinence surgery is low (4%). A large-scale prospective study is necessary to further evaluate this finding.     

Women's quality of life and sexual function after transvaginal anterior repair with mesh insertion

Objective

Current evidence about the impact of pelvic floor surgery on sexual function is conflicting. Only a few studies have reported with validated questionnaires on sexual function after transvaginal mesh repair, with a discrepancy in reported outcomes. The aim of this study was to prospectively explore the impact of anterior repair (AR) with mesh insertion on sexual function, quality of life and dyspareunia.

Study design

69 women with symptomatic stage II or greater prolapse exclusively of the anterior compartment participated in a prospective study on safety and efficacy of two mesh implantation techniques for anterior vaginal wall prolapse repair between September 2007 and May 2009. They were invited to complete the validated condition-specific short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and quality of life (QoL) questionnaires (Pelvic Organ Prolapse (POP) Distress Inventory (POPDI), Urinary Distress Inventory (UDI), POP Impact Questionnaire (POPIQ), and Urinary Impact Questionnaire (UIQ)) pre-operatively and 6 months post-operatively. All data were processed and analyzed in Statistical Computing Environment R, version 2.9.1.

Results

A significant decrease of Qol scores and a significant increase of PISQ-12 scores occurred after surgery. All sexually active women resumed sexual activity postoperatively. The majority of non-sexually active women remained sexually inactive. Postoperatively the frequency of pain during intercourse increased in 31% of cases and decreased or stayed unchanged in 69% of cases. The incidence of de novo dyspareunia after mesh repair was 4% while the incidence of dyspareunia slightly increased from 25% to 29% postoperatively.

Conclusions

The results of this study suggest no deterioration in sexual function, a significant improvement in quality of life and a low incidence of de novo dyspareunia six months after AR with mesh insertion. Despite these findings, the majority of non-sexually active women remain sexually inactive postoperatively. These conclusions should be confirmed in a longer follow-up.     

Incontinencia anal postparto y control evolutivo hasta los doce meses

Objectives

To determine the prevalence of anal incontinence (AI) of faeces and gases, as well as the factors associated with the pregnancy, delivery and postpartum.

Design

Twelve-month follow-up study with visits at 2, 6 and 12 months.

Settings

Vic General Hospital as a basic general hospital in the Osona region (Central Catalonia, Spain).

Subject of the study

Women who had a live birth at full-term between the 1^st of January 2001 and the 31^st of March 2002.

Methodology

During admission for childbirth, data were collected on the mother (age, parity, body mass index, symptoms of incontinence during pregnancy), the type of delivery (vaginal, caesarean) and the foetus (weight, cranial circumference). Two months after parturition, the mothers were examined by a gynaecologist to detect and establish the clinical diagnosis of anal incontinence by means of a specific protocol. The women were asked whether they had symptoms of involuntary release of faeces or gases: women with symptoms of AI underwent a pelvic examination before being referred to a specialist in coloproctology for an assessment. Women with symptoms of AI at 2 months postpartum were recalled at 6 months for a new clinical assessment by the gynaecologist, and after 12 months all those who had shown persistence of symptoms at 6 months were contacted by phone. The prevalence of anal incontinence at 2 months postpartum was calculated and also the association of symptoms with maternal, foetal and delivery factors.

Results

A total of 531 women were visited at 2 months postpartum. Of these, 11 were diagnosed with anal incontinence. At 12 months post partum, 4 (36.4%) of these 11 women continued to have symptoms of incontinence. The prevalence of anal incontinence at 2 months after delivery was 2.1% (95% CI: 1.0-3.7) and was associated with primiparity (Odds ratio [OR] = 7.21, P = 0.029) and forceps use (OR = 5.54, P = 0.021).

Conclusions

The prevalence of AI symptoms at 12 months after parturition was low but in a half of the patients the symptoms were prevalent for more than 6 months. Primiparity and forceps use are associated with the AI symptoms at 2 months postpartum.     

Incontinencia urinaria a los 2 meses posparto. Persistencia de los síntomas a los 6 y 12 meses

Objectives

To determine the prevalence of urinary incontinence (UI) 2 months after delivery as well as the factors associated with delivery and pregnancy. To determine the persistence of UI at 6 and 12 months after delivery among women with UI at 2 months after delivery.

Material and methods

We performed an observational, prospective, longitudinal study with follow-up at 2, 6 and 12 months after inclusion in the study during hospital admission for delivery in the Vic General Hospital, the basic general hospital in the region of Osona (central Catalonia). Women who delivered live newborns at term between 1 January, 2001 and 31 March, 2002 were included. During admission for delivery, data were gathered on 707 women (age, parity, body mass index, symptoms of incontinence during pregnancy), type of delivery (vaginal, cesarean) and fetuses (weight, head circumference). At 2 months after delivery, 531 women were seen by a gynecologists to detect and establish a clinical diagnosis of UI through a specific protocol.Women were asked whether they had involuntary leaks of urine. Women with UI symptoms underwent a pelvic examination and a pad test was requested. Women with UI at 2 months after delivery were called for further clinical evaluation at 6 months. All women with persistent symptoms at the 6-month visit were contacted by telephone at 12 months. The prevalence of UI at 2 months after delivery was calculated and the persistence of symptoms at 6 and 12 months of delivery was determined. The association of IU at 2 months of delivery with maternal, fetal, and delivery-related factors was analyzed by obtaining odds radios (OR) and confidence intervals.

Results

Of the 531 women seen 2 months after delivery, 41 were diagnosed with UI. At 12 months after delivery, 11 (26.8%) of the 41 women with UI had persistent symptoms. The prevalence of UI at 2 months after delivery was 7.7% (95% CI, 5.6- 10.3). A logistic regression model for UI at 2 months (dependent variable), in which the independent variables of type of delivery, maternal age, and weight and head circumference of the newborn were introduced, revealed that UI was associated with vaginal delivery (OR = 14.4; 95% CI, 1.9-107.2).

Conclusions

Vaginal delivery is a known risk factor for UI and our results confirm the impact of this route of delivery in clinical practice in a general hospital. Although severe cases persist, there is substantial reduction in symptoms in the first 12 months.     

Anal incontinence after two vaginal deliveries without obstetric anal sphincter rupture

Purpose

To evaluate prevalence and risk factors for long-term anal incontinence in women with two prior vaginal deliveries without obstetric anal sphincter injury (OASIS) and to assess the impact of anal incontinence-related symptoms on quality of life.

Methods

This is a nation-wide cross-sectional survey study. One thousand women who had a first vaginal delivery and a subsequent delivery, both without OASIS, between 1997 and 2008 in Denmark were identified in the Danish Medical Birth Registry. Women with more than two deliveries in total till 2012 were excluded at this stage. Of the 1000 women randomly identified, 763 were eligible and received a questionnaire. Maternal and obstetric data were retrieved from the national registry.

Results

The response rate was 58.3%. In total, 394 women were included for analysis after reviewing responses according to previously defined exclusion criteria. Median follow-up time was 9.8 years after the first delivery and 6.4 years after the second. The prevalence of flatal incontinence, fecal incontinence and fecal urgency were 11.7, 4.1, and 12.3%, respectively. Overall, 20.1% had any degree of anal incontinence and/or fecal urgency. In 6.3% these symptoms affected their quality of life. No maternal or obstetric factors including episiotomy and vacuum extraction were consistently associated with altered risk of anal incontinence in the multivariable analyses.

Conclusions

Anal incontinence and fecal urgency is reported by one fifth of women with two vaginal deliveries without OASIS at long-term follow-up. Episiotomy or vacuum extraction did not alter the risk of long-term anal incontinence.

     

Cost-effectiveness analysis of the surgical treatment of female urinary incontinence using slings and meshes

Objective

To determine the cost-utility and cost-effectiveness of the surgical treatment of female urinary incontinence using suburethral slings and prolapse meshes compared with therapeutic abstention.

Study design

An economic analysis was performed on 69 women receiving surgical treatment for urinary incontinence using suburethral slings and prolapse meshes. To calculate the procedure's cost-effectiveness, an incremental analysis up to one year was performed using the incremental cost-effectiveness ratio (ICER). The costs were calculated using a cost-by-process model. Answers to the health-related quality of life questionnaires EQ-5D (generic) and International Consultation Incontinence Questionnaire Short-form (specific) were collected before the operation and as well as one month and one year post-operation to calculate the utility, using quality-adjusted life years (QALY), and the effectiveness, respectively. To complete the economic evaluation, we derived confidence ellipses and acceptability curves. The analysis was conducted for the entire sample and also for each type of urinary incontinence.

Results

In total, 45 women presented with stress incontinence, 15 with mixed incontinence and 9 with incontinence associated with prolapse. The average cost per patient at one year post-operation was 1220 €. The QALY achieved at one year was 0.046. The results reveal an ICER at one year of 26,288 €/QALY, which is below the cost-effectiveness threshold considered acceptable, and this value was lower for stress incontinence (21,191 €/QALY). The cost-effectiveness was 106.5 €/International Consultation Incontinence Questionnaire Short-form unit.

Conclusion

Surgery for female urinary incontinence using slings is cost-effective compared with abstention in our public health environment.     

Does the onset or bother of mixed urinary incontinence symptoms help in the urodynamic diagnosis?

Objective

To determine whether evaluation of the first occurring symptom and bother of mixed urinary incontinence (MUI) might help in the clinical assessment of incontinent women.

Study design

Prospective observational study carried out in a tertiary referral urogynaecology unit in London. Women who underwent urodynamic investigations for MUI were asked whether stress or urgency incontinence was the first occurring symptom and which was the most bothersome one. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the first occurring symptom and most bothersome component of their mixed urinary incontinence symptoms in relation to the urodynamic diagnosis were calculated.

Results

One hundred and eighty women with MUI were studied. Initial or most bothersome urgency urinary incontinence (UUI) had a good specificity and PPV for diagnosing detrusor overactivity (DO). When UUI was the initial and most bothersome symptom the specificity and NPV increased up to 93% and 73%. Stress urinary incontinence (SUI) as first occurring or most bothersome had a moderate specificity, PPV and NPV for diagnosing urodynamic stress incontinence (USI). When SUI was the initial and most bothersome symptom the specificity, PPV and NPV increased up to 91%, 70% and 78%. Initial or most bothersome UUI with antecedent or most bothersome SUI had a high specificity and good NPV for a mixed urodynamic diagnosis of DO and USI.

Conclusions

Determination of the first occurring and most bothersome symptom in women with MUI relates closely to the urodynamic diagnosis. Therefore, our symptom-guided approach may in some cases provide useful information directing the clinician towards a more appropriate therapy when urodynamics are inconclusive or cannot be performed.     

Evaluation of postpartum perineal pain and dyspareunia--a prospective study

Objective

Postpartum perineal pain and dyspareunia have been reported to affect 42% of women within the first 2 weeks after their first vaginal delivery. We aimed to determine the prevalence of dyspareunia and perineal pain using validated pain scores following accurate classification of perineal trauma according to the guidelines of the Royal College of Obstetricians and Gynaecologists.

Study design

Prospective study of women having their first vaginal delivery. All women had a perineal and rectal examination. Pain was assessed with a 4-point Verbal Rating Score and an 11-point visual analogue scale on day 1, day 5 and 2 months after delivery.

Results

Two hundred and fifty-four women were invited and 95% participated. Ninety-two percent experienced perineal pain on day one, resolving in 88% (p < 0.001) at 2 months. Compared to an intact perineum or first degree tear significantly more women experienced perineal pain after a second, third or fourth degree tear. Forty percent resumed coitus within 2 months regardless of whether perineal trauma occurred or not. Five days after delivery, uncomplicated episiotomies resulted in more perineal pain than second degree tears.

Conclusions

Although perineal pain affected 92% of mothers, it resolved in the majority within 2 months of delivery. Obstetric anal sphincter injury is associated with more perineal pain than other perineal trauma. Spontaneous second degree tears cause less perineal pain than episiotomies. The 11-point visual analogue scale may be more sensitive than the 4-point Verbal Rating Score.     

Impact of the tension-free vaginal tape obturator procedure on sexual function in women with stress urinary incontinence

Objective

To evaluate prospectively the impact of the tension-free vaginal tape obturator (TVT-O) procedure on sexual function in women with stress urinary incontinence (SUI).

Methods

The present prospective study included women with SUI and no concomitant prolapse who underwent a TVT-O procedure at Fuzhou General Hospital in Fuzhou, Fujian, China. Before and 6 months after surgery, the patients had their sexual function evaluated using the Female Sexual Function Index (FSFI) questionnaire. Only sexually active women were included in the final analysis.

Results

Among the 55 sexually active patients, 21.8% had coital incontinence, which was cured in 11 of 12 patients (91.7%). More than half (54.5%) the women reported an improvement in sexual function after surgery and 45.5% reported no change. No statistically significant difference was found between preoperative and postoperative total or domain (desire, arousal, lubrication, orgasm, satisfaction, and pain) scores on the FSFI.

Conclusion

The TVT-O procedure in women with SUI did not significantly affect sexual function. Further studies are needed to verify the findings and compare the impact of TVT-O on sexual function with that of other anti-incontinence procedures.