Wang Wei, Zhu Lan, Lang Jing-he
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Zhonghua Fu Chan Ke Za Zhi. 2006 Apr;41(4):253-7.
To investigate the change of the patients' sexual function after the surgeries for stress urinary incontinence (SUI).
Pelvic organ prolapse-urinary incontinence sexual function questionnaire (PISQ) was sent to 62 sexually active patients who underwent laparoscopic Burch colposuspension or had a tension free vaginal tape (TVT) inserted at least 6 months after the operation, to a maximum of 3 years. The patient was divided into two groups according to different operations, different follow-up intervals and whether there was concomitant coital incontinence before the operations respectively. The changes of PISQ scores before and after the operation were compared between two groups. For the groups not having significant difference in PISQ score, we compared the rate of PISQ score improvement and the rate of satisfaction postoperatively. Multivariate logistic regression analyses were performed to determine whether age, parity, body mass index, menstrual status, surgical history, medical illness, severity of SUI, concomitant hysterectomy and intraoperative or postoperative complications affected the change of sexual function.
Fifty-six patients answered the questionnaire giving a follow-up rate of 90%. The average score of PISQ was 85.2 +/- 10.7 and 82.4 +/- 17.7 before and after the surgery, and there was no significant difference (P > 0.05); however behavioral emotional domain scores worsened (30.5 +/- 6.6 vs 26.8 +/- 10.7, P < 0.05). The PISQ scores of the patients who underwent the operation within a year declined significantly (86.0 +/- 10.7 vs 77.7 +/- 18.6, P < 0.05), especially in behavioral emotional domain (31.0 +/- 7.2 vs 23.7 +/- 11.3, P < 0.01); however after a year, there was no significant change (84.4 +/- 10.8 vs 86.5 +/- 16.1, P > 0.05) and even an improvement in the physical domain (34.5 +/- 5.6 vs 36.9 +/- 4.3, P < 0.05). Regarding the sexual function improvement ratio, the patients who had the TVT operations (54% vs 12%) or had concomitant coital incontinence before the operations (62% vs 23%) were better (P < 0.01). The change of PISQ scores was independent of clinical features.
The operations of SUI have an adverse effect on the patients' sexual life within a year, which may recover after that period. TVT operation has a better effect on the patients sexual function compared with laparoscopic Burch colposuspension; the patients who have concomitant coital incontinence before the operations have a better sexual function improvement.
探讨压力性尿失禁（SUI）手术后患者性功能的变化。
向62例有性生活的患者发放盆腔器官脱垂-尿失禁性功能问卷（PISQ），这些患者接受了腹腔镜Burch阴道悬吊术或无张力阴道吊带术（TVT），术后至少6个月，最长3年。根据不同手术方式、不同随访时间以及术前是否合并性交失禁将患者分为两组。比较两组手术前后PISQ评分的变化。对于PISQ评分无显著差异的组，比较术后PISQ评分改善率和满意度。进行多因素logistic回归分析，以确定年龄、产次、体重指数、月经状况、手术史、内科疾病、SUI严重程度、是否合并子宫切除术以及术中或术后并发症是否影响性功能变化。
56例患者回答了问卷，随访率为90%。手术前后PISQ平均评分分别为85.2±10.7和82.4±17.7，差异无统计学意义（P>0.05）；但行为情感领域评分恶化（30.5±6.6对26.8±10.7，P<0.05）。术后1年内接受手术的患者PISQ评分显著下降（86.0±10.7对77.7±18.6，P<0.05），尤其是行为情感领域（31.0±7.2对23.7±11.3，P<0.01）；但1年后，无显著变化（84.4±10.8对86.5±16.1，P>0.05），甚至生理领域有所改善（34.5±5.6对36.9±4.3，P<0.05）。在性功能改善率方面，接受TVT手术的患者（54%对12%）或术前合并性交失禁的患者（62%对23%）改善更好（P<0.01）。PISQ评分变化与临床特征无关。
SUI手术在1年内对患者性生活有不良影响，1年后可能恢复。与腹腔镜Burch阴道悬吊术相比，TVT手术对患者性功能的影响更好；术前合并性交失禁的患者性功能改善更好。
