Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands.
J Sex Med. 2022 Jul;19(7):1116-1123. doi: 10.1016/j.jsxm.2022.03.620. Epub 2022 May 12.
Peri-urethral bulking injections (PBI) gain popularity for the treatment of stress urinary incontinence (SUI), but - in contrast to mid-urethral sling (MUS) surgery - little is known about its impact on sexual function.
This was a secondary analysis of a prospective cohort study that included patients with moderate to severe SUI undergoing either MUS surgery or PBI with polydimethylsiloxane Urolastic (PDMS-U). The validated Dutch and English version of the 'Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Function Questionnaire - IUGA Revised' (PISQ-IR) was used to assess sexual function at baseline, at 6 and 12 months of follow-up. For between-group analysis, differences in baseline characteristics were corrected using multivariate analysis of covariance.
The primary outcome was the PISQ-IR single summary score of sexually active (SA) women following both procedures, calculated by mean calculation. Secondary outcomes were the PISQ-IR subscale scores of SA and non-sexually active (NSA) women, the proportions of sexual activity and subjective improvement ('Patient Global Impression of Improvement' (PGI-I)).
A total of 259 women (MUS: n = 146, PBI: n = 113) were included in this study. The PISQ-IR single summary score of SA women improved following both interventions (in the MUS group from 3.2 to 3.4 and in the PBI group from 3.0 to 3.3 after 12 months). After correcting for differences in baseline characteristics, the PISQ-IR summary score at 6 and 12 months was similar for both treatment groups. For SA women, condition-specific and condition-impact subscale scores significantly improved following both procedures.
In treating SUI, PBI is inferior to MUS surgery. However, there is a need for less invasive strategies, especially for women who are unfit for surgery or have contraindications. Sexual function improves after PBI using PDMS-U, which is relevant for the counselling of women with SUI about available treatment options.
STRENGTHS & LIMITATIONS: Strength: until this study, there was a lack of knowledge about the effects of PBI on sexual function.
there may be indication bias as we did not perform a randomized controlled trial.
PBI using PMDS-U and MUS surgery for the treatment of SUI improve sexual function equally in SA women, mainly by decreasing the condition's impact on sexual activity and quality. Latul YP, Casteleijn FM, Zwolsman SE, et al. Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery. J Sex Med 2022;19:1116-1123.
尿道周围注射填充剂（PBI）在治疗压力性尿失禁（SUI）方面越来越受欢迎，但与中尿道吊带（MUS）手术不同，人们对其对性功能的影响知之甚少。
这是一项前瞻性队列研究的二次分析，该研究纳入了接受 MUS 手术或使用聚二甲基硅氧烷 Urolastic（PDMS-U）进行 PBI 的中重度 SUI 患者。使用经过验证的荷兰语和英语版“盆腔器官脱垂和/或尿失禁性功能问卷-国际尿控协会修订版”（PISQ-IR）评估基线、6 个月和 12 个月随访时的性功能。对于组间分析，使用多元协方差分析校正基线特征差异。
共有 259 名女性（MUS 组：n=146，PBI 组：n=113）纳入本研究。接受两种治疗后，活跃性（SA）女性的 PISQ-IR 单一综合评分（通过平均值计算）均有所改善（在 MUS 组中，从 3.2 分提高到 3.4 分，在 PBI 组中，从 3.0 分提高到 3.3 分，12 个月后）。在校正基线特征差异后，两组治疗 6 个月和 12 个月的 PISQ-IR 综合评分相似。对于 SA 女性，两种治疗方法的疾病特异性和疾病影响亚量表评分均显著改善。
在治疗 SUI 方面，PBI 不如 MUS 手术。然而，对于不适合手术或有禁忌症的女性，需要采用创伤更小的策略。使用 PDMS-U 进行 PBI 后，性功能得到改善，这与为患有 SUI 的女性提供可用治疗方案的咨询相关。
