Sexual Function After Transobturator Tape with or Without Concomitant Anterior Colporrhaphy in Women with Stress...

Objectives: To compare sexual function and other clinical outcomes after transobturator tape (TOT) alone versus TOT with concomitant anterior colporrhaphy (AC) in sexually active women with stress urinary incontinence (SUI) and asymptomatic stage ≥ 2 cystocele. Methods: This single-center retrospective cohort study included 173 sexually active women aged 30-50 years who underwent TOT alone (n = 78) or TOT with concomitant AC (TOT+AC, n = 95) between January 2021 and April 2025. Sexual function was assessed using the Female Sexual Function Index (FSFI) preoperatively and at 12 months postoperatively. The primary endpoint was the change in FSFI total score. Secondary outcomes included FSFI domain scores, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Pelvic Organ Prolapse Symptom Score (POP-SS), Visual Analog Scale (VAS) scores, continence status, complications, and patient satisfaction. Results: Both groups showed significant improvements in FSFI total scores at 12 months, with a significantly greater increase in the TOT+AC group than in the TOT group (1.13 ± 0.76 vs. 0.57 ± 0.63, p < 0.001), corresponding to a between-group difference of 0.56 points (95% CI, 0.35-0.77). Improvements in desire (p = 0.004) and arousal (p < 0.001) were also greater in the TOT+AC group, whereas between-group differences in changes in lubrication, orgasm, satisfaction, and pain were not significant. At 12 months, the TOT+AC group had lower ICIQ-SF (2.18 ± 0.97 vs. 2.74 ± 1.11, p < 0.001) and POP-SS (4.02 ± 0.89 vs. 6.62 ± 1.61, p < 0.001) scores and higher patient satisfaction (7.71 ± 1.25 vs. 6.63 ± 1.12, p < 0.001). However, the magnitude of improvement in ICIQ-SF did not differ significantly between groups (p = 0.606). In multivariable linear regression, TOT alone remained independently associated with a smaller improvement in FSFI total score after adjustment for baseline FSFI total score and POP-Q stage (B = -0.610, 95% CI -0.842 to -0.378; p < 0.001). Conclusions: In sexually active women with SUI and asymptomatic stage ≥ 2 cystocele, concomitant AC at the time of TOT was associated with a greater improvement in overall sexual function and prolapse-related symptoms at 12 months compared with TOT alone. However, the absolute between-group difference in FSFI improvement was modest, and its clinical significance remains uncertain. Although postoperative ICIQ-SF scores were lower with TOT+AC, the magnitude of improvement in incontinence symptoms did not differ significantly between groups. These findings suggest that concomitant AC may provide additional functional benefits when individualized preoperative assessment supports combined surgery; however, the present findings do not establish specific selection criteria or support routine AC for all women with asymptomatic stage ≥ 2 cystocele. Prospective randomized studies are needed to confirm these associations and better define which patients may benefit from concomitant repair.