Impact of mid-urethral sling surgery on sexual function in women with stress urinary incontinence: a meta-analysis of randomized controlled trials.

Abstract

Introduction: Mid-urethral slings (MUS) are widely used to treat urinary incontinence. However, there is limited evidence of their long-term effects on female sexual function.

Objectives: To address this gap, this meta-analysis of randomized controlled trials evaluates changes in Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores at 6, 12, 24, and 36 months postoperatively.

Methods: We systematically searched PubMed, Cochrane Central, and Embase for studies evaluating the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores 6, 12, 24, and 36 months after MUS surgery. We performed a single-arm meta-analysis of single means along with their 95% confidence intervals (CIs) by applying a random-effects model. Subgroup analyses based on MUS types (single-incision, retropubic, and transobturator) were performed to evaluate their specific impacts on sexual function outcomes. Statistical analyses were conducted using Review Manager v5.4 and R v4.3.3.

Results: We included 11 randomized controlled trials comprising a total of 2909 patients, of whom 1747 (60.1%) received a transobturator sling, 505 (17.4%) underwent retropubic sling placement, and 657 (22.6%) were treated with a single-incision sling. At 6 months, pooled analysis showed an improvement in sexual function, with a mean change from baseline of 4.49 points (95% CI 3.51 to 5.46). By 12 months, a decrease of 2.68 points (95% CI 0.67 to 4.70) was observed compared with the 6-month assessment. At 24 months, sexual function also declined slightly of -0.52 points (95% CI -2.71 to 1.68; P = 0.31), while at 36 months, there was a slight increase of 0.11 points (95% CI -1.95 to 2.17; P = 0.53). Regarding subgroup analysis, no significant differences among sling types, except at 12 months, when the transobturator group showed greater decline.

Conclusions: Our findings indicate that MUS are associated with an initial improvement in sexual function, particularly at 6 months. However, this improvement is not maintained in long-term follow-up, with scores declining or stabilizing at later time points. These findings are important for patient education and for setting realistic expectations regarding postoperative sexual function.