Reply

Article Outline

• References
• Copyright

We appreciate the interest in our article by Drs Elzevier and Bekker. As we stated in our article, this project was brought about by observing paraurethral banding in some of our patients with a transobturator sling.¹

The commentators bring up the point that the de novo dyspareunia that 3 of our 4 patients with a transobturator sling reported could have been caused by the concurrent prolapse surgery. We did list the concurrent prolapse surgeries, none of which were specifically on the anterior compartment and none of which could have caused the paraurethral banding that we observed. Additionally, we objectively identified the source of the dyspareunia as the paraurethral bands. Furthermore, comprehensive physical examination demonstrated no other areas of discomfort in these patients. There was no difference between the 2 groups in the number or types of concurrent surgeries. De novo dyspareunia was reported in only 4 patients, all of whom displayed paraurethral banding.

Coital incontinence is certainly an important issue that relates to satisfaction after surgery for stress urinary incontinence.² However, the aim of our study was not to look for satisfaction or overall sexual function but to report specifically the paraurethral banding caused by the transobturator sling and to determine whether dyspareunia was experienced because of these bands.

We agree that, with the addition of preoperative female sexual function index scores, we may have been able to show statistical differences in the pain scores between the 2 groups. However, this is not possible, given the retrospective nature of this study. Like many of the studies on sexual function that have been published, which include works by the commentator, this study lacks preoperative information on sexual function.³ However, we certainly do not believe that this article or other similar articles are of “no value.” The discussion that has been generated, the questions that have been formulated, and the future research that will be developed, not to mention the findings and conclusions from the article itself, certainly speak to the value of this kind of work.

As Drs Elzevier and Bekker noted, the message that paraurethral banding was found only in patients that received transobturator slings is important. We found in our study that these bands contributed to a substantial (24%) dyspareunia rate. We recommend a careful inspection of the anterior vaginal wall and consideration of the likelihood of the development of paraurethral bands in preoperative management. We also look forward to additional research in this area to add to the understanding of this potentially troublesome complication.

Back to Article Outline

References 

1. Cholhan HJ, Hutchings TB, Rooney KE. Dyspareunia associated with paraurethral banding in transobturator sling. Am J Obstet Gynecol. 2010;202:481–485
   • View In Article
2. Bekker M, Beck J, Putter H, et al. Sexual function improvement following surgery for stress incontinence: the relevance of coital incontinence. J Sex Med. 2009;6:3208–3213
   • View In Article
   • CrossRef
3. Elzevier HW, Putter H, Delaere K, Venema PL, Nijeholt L, Pelger RCM. Female sexual function after surgery for stress urinary incontinence: transobturator suburethral tape vs tension-free vaginal tape obturator. J Sex Med. 2008;5:400–406
   • View In Article