We read with interest the recent work by Cholhan et al. They introduced a phenomenon they call paraurethral banding , which are palpable bands in the urethral folds. This is an interesting observation that might be helpful in understanding dyspareunia after sling operations.

The results showed that postoperatively 4 of the 25 patients in the transobturator group complained of de novo dyspareunia, compared with no dyspareunia complaints in the retropubic group ( P = .04). Furthermore, paraurethral banding was observed only in the transobturator procedure ( P < .001). This is an important message. However, the complaints of dyspareunia should be compared only within sexually active patients (24% vs 0%). The 4 women with de novo dyspareunia not only underwent the transobturator procedure alone but also 3 of them had undergone concurrent surgery. These concurrent surgeries may have contributed to the de novo complaints of dyspareunia and therefore should have been listed for both groups in their Table 1.

The female sexual function index (FSFI) was used to assess sexual function and was performed only after the operation. The FSFI of the transobturator vs retropubic group showed no significant difference postoperatively, although 3 of the patients in the transobturator group had a FSFI pain score of 0. The writers described the inadequate power as a reason. If we look carefully at the data in their Table 3, the transobturator evaluation was performed in 25 patients after the operation; however, in their Table 3, 17 patients were described as sexually active. In the retropubic group, 16 patients were preoperatively sexually active, and 5 patients became sexually active postoperatively. The best evaluation is to compare the pre- and postoperative FSFI pain score of both groups. It is possible that the pre-FSFI pain score of the transobturator group was initially higher than the retropubic group. Then, the difference in pre- and postoperative FSFI scores between both groups is probably significant.

Another important matter that was not discussed in the article is incontinence during intercourse; coital incontinence is a prognostic factor for improvement of sexual function after incontinence surgery. Without the important information of coital incontinence and a preoperative FSFI, we think that the postoperative evaluation with the FSFI has no value and leads only to discussion.

Future research should be performed to further determine what exactly paraurethral banding is, if it is caused by the transobturator procedure, and if it is correlated with the patients complaints of dyspareunia. We look forward to the results of this future research.