De novo pain and relief of pain after abdominal synthetic mesh implants

摘要

This study assessed the incidence, severity and risk factors for pain after abdominal mesh usage in pelvic floor prolapse surgery. Prospective observational cohort study (NCT01598467, clinical trials.gov) performed in a tertiary referral center for patients with gynecological prolapse. Women undergoing robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy for the treatment of pelvic organ prolapse were​ included (2014–2018). Primary outcome was presence and degree of pre- and postoperative pain. Secondary outcomes were quality of life, dyspareunia and risk factors for postoperative pain. Pre- and postoperative interviews and validated questionnaires were used to assess pain severity and location. A Numeric rating scale (NRS; 0-10; 0 no pain and 10 highest pain score) was included in the questionnaire. ‘De novo pain’, ‘ongoing pain’ and ‘resolved pain’ were respectively described as: Pain solely present postoperatively, pain present both pre- and postoperatively and pain present preoperatively, but resolved postoperatively. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the quality of life Pelvic Floor Impact Questionnaire (PFIQ-7) were used. 115 subjects who underwent abdominal mesh implant surgery were included. Mean follow-up duration was 12.8 3.7 months. The preoperative prevalence of patient self-reported pain was 52%, postoperative self-reported pain was 24%. De novo pain was found in 4.3%. Self-reported ongoing pain was noted in 18%. In 29%of patients the pain had resolved after surgery. Preoperative pain and previous intra-abdominal surgery were identified risk factors for postoperative pain (intra-abdominal surgery OR 3.6, 95% CI 1.2-10.7; preoperative NRS pain score OR 1.4, 95% CI 1.1-1.7). Less women reported dyspareunia postoperatively (49% versus 36%). Total PFIQ-7 scores decreased significantly (Total PFIQ-7: -49) postoperatively, indicating improvement in quality of life. Pain is mostly reduced or resolved and less dyspareunia is reported after abdominal pelvic floor surgery with mesh implants for pelvic organ prolapse.