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Sharifiaghdas and Daneshpajooh: The authors reply: Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh
Letter

Investigative and Clinical Urology 2016; 57(2): 152-153.

Published online: 11 March 2016

DOI: https://doi.org/10.4111/icu.2016.57.2.152

The authors reply: Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh

Farzaneh Sharifiaghdas1, Azar Daneshpajooh2

1Urology-Nephrology Research Center, Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran.

Corresponding Author: Azar Daneshpajooh. Department of Urology, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran. TEL: +98-34-321156, FAX: +98-34-322391, azdaneshpajooh@yahoo.com

Received 20 February 2016       Accepted 23 February 2016

© The Korean Urological Association, 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
To the editor:
We greatly appreciate the interest in our work as commented on in your journal. In our article published in the Korean Journal of Urology in 2015 [1], we concluded that the Nazca-Tc system is effective and safe in the treatment of advanced anterior vaginal wall prolapse with a low rate of complications after medium-term follow-up. One of our study limitations was sexual inactivity in most of our patients. Thus, in the small number of sexually active cases, dyspareunia was confirmed through direct questioning of the patients or via questionnaire.
Pelvic organ prolapse impairs quality of life as a result of vaginal bulge symptoms and change in bladder, bowel, and sexual function. The effect of synthetic meshes on quality of life and sexual function is still being discussed. Overall, the data show that vaginal mesh repair does not interfere with a healthy sexual life. The risk of dyspareunia can be kept to a minimum by ensuring that the mesh lies flat and is placed tension-free [234]. In a review article regarding the impact of pelvic organ prolapse surgery on sexual function, Dietz and Maher [5] concluded that sexual function is similar after anterior polypropylene mesh and anterior colporrhaphy.
In response to the comment, we accept that for evaluating sexual function, high-quality questionnaires and tools such as the Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) are needed. However, as you may consider the topic, evaluation of sexual function was not our primary endpoint. Accordingly, beside the other evaluations in such patients, to draw additional information, we decided to use a short and simple assessment for sexual function.
Finally, our study was not a basic evaluation of sexual function after pelvic organ prolapse surgery; therefore, we did not mention this in the details. To reach better results, it would be better to use validated questionnaires for measuring sexual function in patients before and after prolapse surgery and report these measures.

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

References

1. Sharifiaghdas F, Daneshpajooh A, Mirzaei M. Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh. Korean J Urol. 2015; 56:811–816.
2. Rane A, Iyer J, Kannan K, Corstiaans A. Prospective study of the PerigeeTM system for treatment of cystocele - our five-year experience. Aust N Z J Obstet Gynaecol. 2012; 52:28–33.
3. Moore RD, Beyer RD, Jacoby K, Freedman SJ, McCammon KA, Gambla MT. Prospective multicenter trial assessing type I, polypropylene mesh placed via transobturator route for the treatment of anterior vaginal prolapse with 2-year follow-up. Int Urogynecol J. 2010; 21:545–552.
4. Gauruder-Burmester A, Koutouzidou P, Tunn R. Effect of vaginal polypropylene mesh implants on sexual function. Eur J Obstet Gynecol Reprod Biol. 2009; 142:76–80.
5. Dietz V, Maher C. Pelvic organ prolapse and sexual function. Int Urogynecol J. 2013; 24:1853–1857.
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