Impact of mid-urethral sling surgery on sexual function in women with stress urinary incontinence: a meta-analysis of randomized controlled trials

Abstract Introduction Mid-urethral slings (MUS) are widely used to treat urinary incontinence. However, there is limited evidence of their long-term effects on female sexual function. Objectives To address this gap, this meta-analysis of randomized controlled trials evaluates changes in Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores at 6, 12, 24, and 36 months postoperatively. Methods We systematically searched PubMed, Cochrane Central, and Embase for studies evaluating the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 scores 6, 12, 24, and 36 months after MUS surgery. We performed a single-arm meta-analysis of single means along with their 95% confidence intervals (CIs) by applying a random-effects model. Subgroup analyses based on MUS types (single-incision, retropubic, and transobturator) were performed to evaluate their specific impacts on sexual function outcomes. Statistical analyses were conducted using Review Manager v5.4 and R v4.3.3. Results We included 11 randomized controlled trials comprising a total of 2909 patients, of whom 1747 (60.1%) received a transobturator sling, 505 (17.4%) underwent retropubic sling placement, and 657 (22.6%) were treated with a single-incision sling. At 6 months, pooled analysis showed an improvement in sexual function, with a mean change from baseline of 4.49 points (95% CI 3.51 to 5.46). By 12 months, a decrease of 2.68 points (95% CI 0.67 to 4.70) was observed compared with the 6-month assessment. At 24 months, sexual function also declined slightly of −0.52 points (95% CI −2.71 to 1.68; P = 0.31), while at 36 months, there was a slight increase of 0.11 points (95% CI −1.95 to 2.17; P = 0.53). Regarding subgroup analysis, no significant differences among sling types, except at 12 months, when the transobturator group showed greater decline. Conclusions Our findings indicate that MUS are associated with an initial improvement in sexual function, particularly at 6 months. However, this improvement is not maintained in long-term follow-up, with scores declining or stabilizing at later time points. These findings are important for patient education and for setting realistic expectations regarding postoperative sexual function.