The AdVance sling and male sexual function: A prospective analysis on the impact of pelvic mesh on erectile and orgasmic domains in sexually active men with post-prostatectomy stress urinary incontinence

Abstract

ABSTRACT Introduction The transvaginal pelvic mesh surgery has been shown to cause female sexual dysfunction. Given this pelvic mesh concern in women, there is similar concern whether men who received pelvic mesh for postprostatectomy stress incontinence (PPSI) may suffer from sexual dysfunction too. Objective To evaluate the sexual function impact of AdVance pelvic male sling (PMS) on erectile and orgasmic domains. Methods A review of a prospectively collected database was conducted in all sexually active men who underwent AdVance MS for PPSI between 2012 and 2018. Patient demographics, clinical outcomes and validated questionnaires such as the Brief Sexual Function Inventory (BSFI), International Index of Erectile Function (IIEF) and Patient Global Impression of Improvement (PGI-I) were reviewed at 6, 12 and 48 months. Results Of the total of 65 men who received AdVance PMS, an increase in IIEF-5 score ≥ 5 points were reported in 10 (15%) patients with no patients complained of deteriorating erectile function at 24 months. The improvement in orgasmic function (Question 10 on IIEF-15) was reported in 22 (34%) patients while 3 (5%) patients reported lower orgasmic score. The sexual domains scores in BMSFI were higher in 40 (62%) patients especially with regards to sexual desire (Question 1 and 2) and satisfaction with sex life (Question 11). No patient reports pelvic or urethral pain. The reported improvement in erectile and orgasm scores remained similar throughout the 24-months follow-up period. All 20 patients with preoperative climacturia reported resolution of their symptoms during sexual activity. The overall PGI-I was 1.4 (1-3) and men with a higher continence rate were more likely to report better male sexual function (p=0.044). Conclusions Despite the reported adverse outcomes of pelvic mesh in female sexual dysfunction, the AdVance PMS appears to improve male sexual function with regards to erectile and orgasm domains. Disclosure Work supported by industry: no.