Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill (Drs. Geller and Wu).
Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Evanston, Illinois (Drs. Bretschneider and Kenton).
J Minim Invasive Gynecol. 2021 Sep;28(9):1603-1609. doi: 10.1016/j.jmig.2021.01.021. Epub 2021 Jan 27.
To evaluate sexual function in women undergoing minimally invasive total hysterectomy and sacrocolpopexy (TLH + SCP) with a lightweight polypropylene Y-mesh 1 year after surgery.
This was a planned secondary analysis of a 5-site randomized trial comparing permanent (2-0 Gore-Tex; W. L. Gore & Associates, Inc., Newark, DE) vs absorbable suture (2-0 polydioxanone suture) for vaginal attachment of a Y-mesh (Upsylon; Boston Scientific Corporation, Natick, MA) graft during TLH + SCP.
Multicenter trial at 5 study sites (4 academic and 1 community). The study sites were: (1) University of North Carolina at Chapel Hill, Chapel Hill, NC; (2) Wake Forest Baptist Hospital, Winston-Salem, NC; (3) Northwestern University, Evanston, IL; (4) Georgia Regents University, Augusta, GA; and (5) Atlantic Health Medical Group, Morristown, NJ.
Women previously enrolled in an original study undergoing TLH + SCP.
Quality-of-life questionnaires and physical examination.
The primary objective was to assess changes in sexual function at 1 year after surgery as measured by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, International Urogynecological Association-Revised. The secondary objective was to assess the factors associated with postoperative sexual activity and dyspareunia. Of the 200 participants enrolled, 182 (92.8%) completed follow-up: n = 95/99 Gore-Tex and n = 87/101 polydioxanone suture. The mean age was 60 ± 10 years; body mass index was 27 ± 5 kg/m; 78% were menopausal and 56% sexually active before surgery. At 1 year after surgery, 63% were sexually active: 93% of the sexually active women preoperatively remained so at 1 year, and 24% reported new sexual activity at 1 year (p <.001). Sexual function at 1 year showed marked improvement in activity, quality, and arousal/orgasm compared with baseline Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire scores. Dyspareunia rates decreased from 22% preoperatively to 16.5% at 1 year (p = .65). Women who were sexually active at 1 year were younger (56.8 ± 9.6 years vs 65.4 ± 9.2 years, p <.001), more likely to be premenopausal (31.6% vs 7.4%, p = .001), and less likely to undergo bilateral salpingo-oophorectomy (53.3% vs 78.9%, p <.001).
Women undergoing TLH + SCP with a lightweight mesh graft report increased rates of sexual activity, improved sexual quality and arousal/orgasm, and lower rates of dyspareunia at 1 year after surgery.
评估在微创全子宫切除术和骶骨阴道固定术（TLH+SCP）后 1 年接受轻重量聚丙烯 Y 网片治疗的女性的性功能。
这是对 5 个地点随机试验的二次分析，比较了永久性（2-0 Gore-Tex；W. L. Gore & Associates，Inc.，Newark，DE）和可吸收缝线（2-0 聚二氧杂环已酮缝线）在 TLH+SCP 中阴道附着 Y 网片（Upsylon；Boston Scientific Corporation，Natick，MA）时的情况。
在 5 个研究地点（4 个学术地点和 1 个社区）进行的多中心试验。研究地点为：（1）北卡罗来纳大学教堂山分校，教堂山，NC；（2）维克森林浸信会医疗中心，温斯顿-塞勒姆，NC；（3）西北大学，埃文斯顿，IL；（4）格鲁吉亚摄政大学，奥古斯塔，GA；和（5）大西洋健康医疗集团，莫尔里斯镇，NJ。
先前参加 TLH+SCP 的原始研究的女性。
生活质量问卷和体格检查。
主要目的是通过盆腔器官脱垂/尿失禁性问卷调查，评估术后 1 年的性功能变化，国际尿控协会修订版。次要目的是评估与术后性活动和性交痛相关的因素。在 200 名入组的参与者中，182 名（92.8%）完成了随访：n=95/99 Gore-Tex 和 n=87/101 聚二氧杂环已酮缝线。平均年龄为 60±10 岁；体重指数为 27±5kg/m；78%处于绝经后状态，56%术前有性生活。术后 1 年，63%有性生活：93%术前有性生活的女性在 1 年后仍有性生活，24%报告在 1 年后有新的性生活（p<.001）。与基线盆腔器官脱垂/尿失禁性问卷调查评分相比，术后 1 年的活动、质量和唤醒/高潮的性功能明显改善。性交痛的发生率从术前的 22%下降到术后 1 年的 16.5%（p=0.65）。1 年后有性生活的女性更年轻（56.8±9.6 岁 vs 65.4±9.2 岁，p<.001），更有可能处于绝经前状态（31.6% vs 7.4%，p=0.001），不太可能接受双侧输卵管卵巢切除术（53.3% vs 78.9%，p<.001）。
在微创全子宫切除术和骶骨阴道固定术（TLH+SCP）后接受轻重量网片治疗的女性报告在术后 1 年有更高的性生活频率、改善的性生活质量和唤醒/高潮，以及更低的性交痛发生率。
