Route matters: comparing vaginal (TOT) and laparoscopic (MERT-Burch) approaches in stress urinary incontinence and postoperative sexual function recovery.

Abstract

<h4>Background</h4>Stress urinary incontinence (SUI) negatively affects women's sexual well-being and quality of life through anxiety about urine leakage during intercourse.<h4>Aim</h4>To compare the effects of vaginal (transobturator tape, TOT) and laparoscopic (Multiple Endoclip Retraction Technique-Burch, MERT-Burch) routes on postoperative sexual function, quality of life, and time to comfortable coitus.<h4>Methods</h4>This retrospective study included 114 sexually active women who underwent TOT (n = 55) or laparoscopic MERT-Burch colposuspension (n = 59) between January 1, 2021, and August 5, 2025. Pre- and 6-month postoperative data were collected using validated questionnaires: International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Urogenital Distress Inventory-6 (UDI-6), Incontinence Quality of Life Questionnaire (I-QOL), Female Sexual Function Index (FSFI), and International Index of Erectile Function-5. Complications were graded by the Clavien-Dindo system.<h4>Outcomes</h4>Primary outcomes were postoperative improvement in sexual function and the timing of first and comfortable coitus.<h4>Results</h4>The mean age and body mass index were similar between groups. The MERT-Burch group resumed sexual activity significantly earlier (first coitus: 7 vs 35 days; comfortable coitus: 15 vs 54 days, P < .001). Both procedures improved ICIQ-SF, UDI-6, I-QOL, and FSFI scores (P < .001). Persistent dyspareunia occurred in 14.5% of TOT patients but in none after MERT-Burch. No major complications were recorded.<h4>Clinical implications</h4>Route of surgery affects postoperative sexual comfort and the time to first comfortable coitus, favoring the non-vaginal, mesh-free laparoscopic approach.<h4>Strengths & limitations</h4>Use of validated scales and the novel "first comfortable coitus" parameter are strengths; retrospective design and limited follow-up are limitations.<h4>Conclusion</h4>Both techniques effectively restore continence, but the laparoscopic MERT-Burch provides earlier and more comfortable sexual recovery, establishing "first comfortable coitus" as a practical indicator of postoperative sexual healing.