Department of Urology, Careggi University Hospital, University of Florence, Florence, Italy.
Department of Urology, Careggi University Hospital, University of Florence, Florence, Italy.
Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:282-287. doi: 10.1016/j.ejogrb.2019.07.027. Epub 2019 Jul 22.
Pelvic Organ Prolapse (POP) may impair sexual health. Though sexual dysfunction in women with POP is associated with reduced sexual arousal and dyspareunia, sexual outcomes have not been fully investigated. Transvaginal mesh repair (TVMR) is a POP therapeutic option, but is debated as a possible cause of worsening in sexual function. Aim of this study is to evaluate pre- and post-operative sexual outcomes in women undergone to TVMR.
Data coming from sexually active women submitted to TVMR for POP with commercial mesh kits (device whose production has been suspended) were prospectively collected from 2012 to 2016 in a tertiary referral center. POP was measured according to the POP-Q classification. Patients' characteristics, operative and post-operative data were collected. Follow-up was carried out at month 1, 6, 12 and then yearly. Sexual function was measured through FSFI (Female Sexual Function Index) questionnaire. Minimum follow up was 12 months. FSFI score was assessed in these women before and after TVMR. A sub-analysis according to mesh kit used was made.
From 2012 to 2016, 155 women underwent TVMR active for stage III or higher POP and 56 (36.6%) were sexually active, while 52 (92.9%) had adequate follow-up. Median age was 62 years (IQR 56-66), median BMI was 24,7 kg/m2 (IQR 22,3-28,9) and median parity was 2 (IQR 1-2). All patients presented anterior compartment POP and 14 (269%) had previous POP surgery. Urodynamic SUI was present in 13 (250%) patients. Commercial mesh kits used were Prolift© in 19 patients (36.5%) and Elevate© in 33 (63.5%). Median follow up was 42 months (IQR 22-59). Globally, FSFI was unaltered from TVMR at 12 months and at last follow up (p = 0.856). In detail, even if dyspareunia was reported in 1 patient, pain sub score was stable at long term follow up after TVMR (p = 0.124). Globally, there were 8 (15.4%) perioperative complications, none exceeding Clavien 2. At late follow up here was 1 (1.9%) mesh vaginal erosion occurred and there were 4 (7.7%) de novo stress urinary incontinence. Preoperative characteristics, surgical complications and outcomes were similar between mesh kits (p > 0.05).
In our experience, global sexual function doesn't seem to be affected by TVMR when performed by expert surgeons. Despite being a confounding factor, lost at follow up rate was low, thus affecting only in a mild way surgical outcomes. Also ageing might be a confounding factor during follow up to establish real mesh impact on sexual function. Dyspareunia was a rare complication in patients during follow-up and pain was not a major complaint.
盆腔器官脱垂（POP）可能会影响女性的性生活健康。尽管患有 POP 的女性的性功能障碍与性欲降低和性交困难有关，但她们的性生活结局并未得到充分研究。经阴道网片修补术（TVMR）是一种治疗 POP 的方法，但也有人认为它可能会导致性功能恶化。本研究的目的是评估接受 TVMR 治疗的女性的术前和术后性生活结局。
从 2012 年至 2016 年，前瞻性地收集了在一家三级转诊中心接受 TVMR 治疗的商业网片套件（已停产的装置）治疗的 POP 且有性生活的女性的数据。POP 根据 POP-Q 分类进行测量。收集患者的特征、手术和术后数据。随访在术后 1 个月、6 个月、12 个月进行，之后每年进行一次。通过女性性功能指数（Female Sexual Function Index，FSFI）问卷评估性生活质量。最小随访时间为 12 个月。评估了这些女性在 TVMR 前后的 FSFI 评分。根据使用的网片套件进行了亚组分析。
2012 年至 2016 年间，155 名女性因 III 期或更高级别的 POP 接受了 TVMR 治疗，其中 56 名（36.6%）有性生活，52 名（92.9%）有足够的随访。中位年龄为 62 岁（IQR 56-66），中位 BMI 为 24.7kg/m2（IQR 22.3-28.9），中位产次为 2（IQR 1-2）。所有患者均存在前盆腔 POP，14 名（26.9%）曾接受过 POP 手术。13 名（25.0%）患者存在尿动力学压力性尿失禁。使用的商业网片套件为 Prolift©19 例（36.5%）和 Elevate©33 例（63.5%）。中位随访时间为 42 个月（IQR 22-59）。从 TVMR 到 12 个月和最后一次随访，FSFI 总体上没有改变（p=0.856）。具体来说，即使 1 名患者报告存在性交困难，TVMR 后长期随访时疼痛亚评分仍保持稳定（p=0.124）。总体而言，有 8 名（15.4%）患者发生围手术期并发症，无一例超过 Clavien 2 级。在晚期随访中，有 1 例（1.9%）发生网片阴道侵蚀，有 4 例（7.7%）新发生压力性尿失禁。网片套件之间的术前特征、手术并发症和结局相似（p＞0.05）。
根据我们的经验，在经验丰富的外科医生进行 TVMR 时，整体性功能似乎不会受到影响。尽管存在混杂因素，但失访率较低，仅对手术结局产生轻微影响。此外，在随访期间年龄增长可能也是一个混杂因素，从而影响网片对性功能的真正影响。在随访期间，性交困难是患者的一个罕见并发症，疼痛也不是一个主要的抱怨。
