Urinary incontinence is a common disorder that affects up to 25% of women. It is strongly linked to lower quality of life (QOL) and sexual dysfunction [1]. Sexual function may improve if incontinence is cured without generating new adverse effects (e.g., pain, mesh erosion). Sexual function is negatively impacted by surgical and post-operative complications such as de novo urgency, pain, and dyspareunia. Examining changes in sexual function after incontinence surgery yields inconclusive findings, with some studies reporting progress, others reporting worsening, and still others reporting no change in sexual function complaints [2]. FSFI (Female Seuxal Function Index) is a practical multidimensional scale for assessing female sexual function; a score of 26.55 differentiates women with and without sexual dysfunction [3]. The aim of this study is to evaluate the efficacy and alterations in sexual function following the therapy of female stress urinary incontinence (SUI) with a single-incision mid-urethral sling (SIMS) under local anesthesia.

A prospective cohort study was conducted in a Urogynecologic unit of a tertiary academic center from December 2019 to January 2023. All patients consecutively treated with SIMS for SUI were included. The patients presented with SUI, and they were initially examined in the outpatient department (history, POP-Q, cough stress test, urodynamic exam). All patients with concomitant pelvic organ prolapse, previous incontinence surgery, or no sexual life were excluded. Patients’ continence status and sexual life were evaluated using standard questionnaires (ICIQ-SF, FSFI, PISQ-12). The patients were evaluated at 24 months with a clinical examination that including a stress test, check for erosion, and questionnaires (PGI-I, PGI-S, ICIQ-SF, FSFI, PISQ-12). Statistical analysis was performed with Microsoft EXCEL.

A total of 50 Caucasian sexually active women consecutively underwent SIMS for SUI and returned for a 24-month follow-up; demographics are shown in Table 1. At the 24 months follow-up, the stress test was negative in 96% (48/50), 94% (47/50) had PGI-I scores 1 and 2, and 84% (42/50) had PGI-S score 1. Mean ICIQ-SF score decreased from 13.76±2.97 preoperative to 2.26±2.93 at 24 months follow up. No mesh erosion was recognized (Table 1). 
A total of 31 patients (62%) showed improvement in total FSFI scores, whereas 9 patients (18%) showed deterioration, and 10 patients (20%) had no changes on the FSFI questionnaire. The mean total FSFI score was statistically significantly improved from 18.85±9.10 to 21.62±8.61. Preoperatively, only 13 patients (26%) had scores showing normal sexual function, while 37 patients (74%) had FSFI total values >26. Following a 24-month follow-up, the number of patients without female sexual dysfunction increased to 38% (19/50). When evaluating the PISQ-12 results, 39 patients (78%) demonstrated an increase in total scores, while 8 patients (16%) demonstrated a decrease, and 3 patients (6%) exhibited no change. The mean total PISQ-12 score was statistically significantly improved from 29.20± 7.30 to 35.26±5.11. If we separate the patients into 2 groups, menopausal (n=35) or not (n=15), we observe the same significant improvement to the mean total FSFI score (15.71±8.48 to 188.37±8.19 and 26,17±5.80 to29.21±2.89) and PISQ-12 score (27,57±6.35 to 33.66±4.87 and 33.00±8.15 to 39.00±3.55) in both groups. (Table 2)
A total of 50 Caucasian sexually active women consecutively underwent SIMS for SUI and returned for a 24-month follow-up; demographics are shown in Table 1. At the 24 months follow-up, the stress test was negative in 96% (48/50), 94% (47/50) had PGI-I scores 1 and 2, and 84% (42/50) had PGI-S score 1. Mean ICIQ-SF score decreased from 13.76±2.97 preoperative to 2.26±2.93 at 24 months follow up. No mesh erosion was recognized (Table 1). 
A total of 31 patients (62%) showed improvement in total FSFI scores, whereas 9 patients (18%) showed deterioration, and 10 patients (20%) had no changes on the FSFI questionnaire. The mean total FSFI score was statistically significantly improved from 18.85±9.10 to 21.62±8.61. Preoperatively, only 13 patients (26%) had scores showing normal sexual function, while 37 patients (74%) had FSFI total values >26. Following a 24-month follow-up, the number of patients without female sexual dysfunction increased to 38% (19/50). When evaluating the PISQ-12 results, 39 patients (78%) demonstrated an increase in total scores, while 8 patients (16%) demonstrated a decrease, and 3 patients (6%) exhibited no change. The mean total PISQ-12 score was statistically significantly improved from 29.20± 7.30 to 35.26±5.11. If we separate the patients into 2 groups, menopausal (n=35) or not (n=15), we observe the same significant improvement to the mean total FSFI score (15.71±8.48 to 188.37±8.19 and 26,17±5.80 to29.21±2.89) and PISQ-12 score (27,57±6.35 to 33.66±4.87 and 33.00±8.15 to 39.00±3.55) in both groups. (Table 2)

Evaluation of sexual function pre-operatively and 24 months post-operatively revealed a statistically significant improvement in all domains except pain as measured by FSFI scores. Examining the impact of urinary incontinence using the FSFI and PISQ-12 reported poorer sexual function in women with pelvic floor disorders. The treatment of urinary incontinence with SIMS leads not only to a significant improvement in continence but also in sexual function.

SIMS may be a useful technique in the treatment of SUI. They have a high success rate, low morbidity and led to improvements in continence and sexual function at 24 months of postoperative follow-up

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