52 CHANGES IN CLITORIAL BLOOD FLOW FOLLOWING SURGERY WITH TENSION-FREE VAGINAL MESH FOR PELVIC ORGAN PROLAPSE

Abstract

INTRODUCTION AND OBJECTIVES: In the previous study, we reported a significant improvement in sexual function outcome following the surgery with tension-free vaginal mesh (TVM) for pelvic organ prolapse (POP). We evaluated the effect of TVM procedure on clitorial blood flow and sexual function in women with POP. METHODS: The study was conducted with 30 patients who underwent TVM for surgical correction of pelvic organ prolapse. Doppler ultrasonography was performed using a commercially available color Doppler scanner (prosound -7, ALOKA, Tokyo, JAPAN) with a 12 mHz linear array transducer. The Doppler translabial probe was placed sagittally on the clitoris at an angle of less than 20°, without exerting any significant pressure on the tissues. After identifying the clitoral artery using color flow mapping, the Doppler probe was positioned over the vessel and at least three sequential Doppler waveforms were obtained. We measured the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) of the clitoral arteries, before and 1, 3, 6 months postoperatively. Female sexual function was also investigated with the Female Sexual Function Index (FSFI) which was a 19-question, self-report measure, organized in a 6-domain structure, including desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. RESULTS: One month after surgery, the mean PI and RI, which reflect blood flow impedance, increased and both parameters significantly decreased 6 months after surgery. (P 0.05). On the other hand, the mean PSV and EDV decreased one month after surgery, and then increased at 6 months after surgery. These 4 parameters recovered at 6 months after surgery. Total FSFI scores were deteriorated from 10.2 7.9 at baseline to 7.0 4.3 at 3 months, and then improved significantly to 18.2 8.9 at 6 months after surgery. As the PI and RI decreased, FSFI scores tended to increase; and they also tended to increase as the PSV and EDV increased. CONCLUSIONS: Color Doppler ultrasonography appears to be feasible and useful in measuring both baseline and post-treatment condition of clitorial blood flow in patients treated with TVM for POP. Further studies are necessary to investigate the effect of clitorial blood flow changes on female sexual function in various clinical settings.