Impact of incontinence surgery on sexual function: a systematic review and meta-analysis.

INTRODUCTION Urinary incontinence has an adverse impact on sexual function. The reports on sexual function following the treatment of urinary incontinence are confusing. AIM To investigate the impact of surgery for stress incontinence on coital incontinence and overall sexual function. METHODS Cochrane Incontinence Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for trials of incontinence surgery assessing sexual function and coital incontinence before and after surgery. Observational studies and randomized controlled trials investigating the impact of surgical correction of stress urinary incontinence on sexual function were included. Surgical interventions included tension-free vaginal tape (TVT), Tension Free Vaginal Tape-Obturator (TVT-O), transobturator tape (TOT), Burch, and autologous fascial sling (AFS). Studies that included patients undergoing concurrent prolapse surgery were excluded from the analysis. Data extraction and analysis was performed independently by two authors. Coital incontinence was analyzed separately and odds ratios (ORs) with 95% confidence intervals (CI ) calculated. The data were analyzed in Review Manager 5 software. MAIN OUTCOME MEASURE Changes in sexual function and coital incontinence following surgery for urinary incontinence. RESULTS Twenty-one articles were identified, which assessed sexual function and/or coital incontinence following continence surgery in the absence of prolapse. Results suggest evidence for a significant reduction in coital incontinence post surgery (OR 0.11; 95% CI 0.07, 0.17). CONCLUSIONS Coital incontinence is significantly reduced following continence surgery. There were several methodological problems with the quality of the primary research particularly related to heterogeneity of studies, use of different outcome measures, and the absence of well-designed randomized controlled trials.