1 3 World J Urol (2016) 34:1499–1500 DOI 10.1007/s00345-016-1858-7 LETTER TO THE EDITOR Comment on “efficacy and safety of skeletonized mesh implants for advanced pelvic organ prolapse: 12 month follow up” Antonio Simone Laganà 1 · Fabrizio Sapia 2 · Salvatore Butticè 3 · Gaetano Valenti 2 · Salvatore Giovanni Vitale 1 Received: 2 April 2016 / Accepted: 17 May 2016 / Published online: 25 May 2016 © Springer-Verlag Berlin Heidelberg 2016 and validated questionnaires were used. As we previously indicated [3], several analytical tools are available in the literature for the evaluation of sexual function in patients undergoing surgery for POP and stress urinary inconti- nence, including the Female Sexual Function Index (FSFI) questionnaire [4, 5] and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) [6]: these two questionnaires, in particular, are designed to measure objectively different areas of sexual function as well as behavioral/emotional and partner-related factors. Consider- ing the lack of measurable elements and consequent repro- ducibility, the data analysis by Weintraub et al. [1] about sexual function could be considered severely biased, and the conclusion flawed. Previous data suggest that there is a corresponding asso- ciation between sexual heath and clitoral vascularization evaluated by color Doppler sonography [7]. Regarding this point, we already indicated [8] that surgical techniques that provide perforation of the paraurethral spaces to place suburethral slings can diminish sexual function due to scars and reduced elasticity of the vaginal wall, which may result in reduced blood supply to the erectile tissues of the clitoris and, consequently, may have a detrimental effect on sexual function. Nevertheless, we previously showed [9] that the treatment of severe (third and fourth degree, according to Baden and Walker’s classification) cystocele using a bio- compatible porcine dermis graft improves quality of life and sexual function without any change in clitoral blood flow, suggesting that this last parameter may be only partly responsible for the reported improvement and cannot allow us to draw a firm conclusion about sexual health if consid- ered alone. Basing on these data and our experience, we strongly suggest the use of standardized and validated question- naires (alone or in combination with clitoral vascularization Dear Editor, We read with great interest the recent study of Weintraub et al. [1], published on your prestigious journal, which focused on the efficacy and safety of skeletonized mesh implants for pelvic organ prolapse (POP). As widely evi- denced [2], this acquired anatomical condition has a detri- mental effect on patient’s daily activities, quality of life and sexual function. The authors performed a prospective study, evaluating urinary and fecal urgency, frequency, stress and urgency incontinence, impairment of sexual function, void- ing habits, pelvic pain and bulging symptoms at 6 weeks, 6 and 12 months after surgery. According to their data anal- ysis, there was a significant improvement in sexual activ- ity, documented by dyspareunia rates that progressively decreased over time (approximately 30 % before surgery and 5 % at 12-month follow-up). Although we appreciate the accurate reported method- ology, we would like to take the opportunity to point out several elements which would let us better use the results of this study. Indeed, we think that no robust conclusion can be drawn regarding sexual function, since no standard This comment refers to the article available at doi:10.1007/s00345-016-1792-8. * Antonio Simone Laganà antlagana@unime.it 1 Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via C. Valeria 1, 98125 Messina, Italy 2 Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy 3 Unit of Urology, Department of Human Pathology, University of Messina, Messina, Italy Author's personal copy