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Sexual and functional outcomes after prolapse surgery: a randomized prospective comparison of trocarless transvaginal mesh and pelvic organ prolapse suspension

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Abstract

Purpose

Stress urinary incontinence (SUI) related to pelvic organ prolapse represents a common condition that negatively impacts female sexual activity. Laparoscopic pelvic organ prolapse surgery (POPs) and the anterior repair with a trocar-less trans-vaginal mesh (TTMs) represent two different surgical techniques to treat SUI secondary to POP. This study aimed to report the results of these techniques comparing the sexual and functional outcome improvement.

Materials and methods

Fifty-nine sexually active female patients, complaining of urodynamic stress incontinence, were enrolled in this prospective study, and simply randomized in two groups: 29 POPs and 30 TTMs. All patients were studied at baseline and 6 months after surgery. Preoperative evaluation included medical history, urodynamic test, Female Sexual Function Index (FSFI), and pelvic magnetic resonance defecography. Six months after surgery, all patients completed the FSFI and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and were investigated with a uroflowmetry test with post-void residual volume (PVR).

Results

At 6 months after surgery, 87% of POPs patients and 79% of TTMs subjects resulted dry. No statistically significant results were obtained in terms of urinary outcomes between the two surgical groups. Regarding sexual function, POPs group exhibited a significant greater improvement of global FSFI (mean: 27.4; SD: 4.31) compared to TTMs group (mean FSFI: 23.56; SD: 2.28; p-value ≤ 0.0001).

Conclusions

Our results indicated that POPs and TTMs lead to satisfactory and safe functional outcomes with a good recovery of urinary continence. Furthermore, POPs, when compared to TTMs, led to a greater improvement of sexual function.

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Authors and Affiliations

  1. Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, ICOT, Corso della Repubblica 79, 04100, Latina, Italy

    Andrea Fuschi, Alessia Martoccia, Yazan Al Salhi, Martina Maggi, Lorenzo Capone, Paolo Pietro Suraci, Alice Antonioni, Mauro Cervigni, Antonio Carbone & Antonio Luigi Pastore

  2. ICOT - Surgery, Orthopedy, Traumatology Institute, Latina, Italy

    Andrea Fuschi, Yazan Al Salhi & Mauro Cervigni

  3. Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy

    Martina Maggi

  4. Department of Urology, ASST Valle Olona, Busto Arsizio, Varese, Italy

    Giorgio Bozzini

  5. Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, TR, Italy

    Ester Illiano & Elisabetta Costantini

  6. Department of Translationals Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Alessandro Zucchi

Authors
  1. Andrea Fuschi
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  2. Alessia Martoccia
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  3. Yazan Al Salhi
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  4. Martina Maggi
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  5. Lorenzo Capone
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  6. Paolo Pietro Suraci
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  7. Alice Antonioni
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  8. Giorgio Bozzini
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  9. Ester Illiano
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  10. Elisabetta Costantini
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  11. Alessandro Zucchi
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  12. Mauro Cervigni
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  13. Antonio Carbone
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  14. Antonio Luigi Pastore
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Contributions

AF, AM, YAS, PPS, LC, AA, and ALP: data collection, statistical analysis, formal analysis, methodology, and writing original draft. AA, MM, GB, EI, and AZ: data curation and writing original draft. EC, MC, AC, and ALP: review and editing. ALP, AM, AF, AZ, MC, and AC: conceptualization and methodology.

Corresponding author

Correspondence to Antonio Luigi Pastore.

Ethics declarations

Ethics approval

The study was performed in accordance with the Ethical Principles for Medical Research Involving Human Subjects (World Medical Association, The Declaration of Helsinki Principles, 2000). The study was approved by the local ethical committee of Sapienza University Pharmacy and Medicine Faculty, Latina, Italy (ASL LT approval n. CE17/1124/17 UROLTUNIV).

Consent to participate

Written informed consent forms were obtained from all the patients before study enrollment.

Conflict of interest

The authors declare no competing interests.

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Andrea Fuschi and Alessia Martoccia have equally contributed to the manuscript, so they both have to be considered as first author.

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Fuschi, A., Martoccia, A., Al Salhi, Y. et al. Sexual and functional outcomes after prolapse surgery: a randomized prospective comparison of trocarless transvaginal mesh and pelvic organ prolapse suspension. Langenbecks Arch Surg 407, 1693–1700 (2022). https://doi.org/10.1007/s00423-022-02458-z

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