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

Abstract

Introduction: This study assessed the incidence, severity and risk factors for pain after abdominal mesh usage in pelvic floor prolapse surgery. Methods: 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. Results: 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. Conclusion: Pain is mostly reduced or resolved and less dyspareunia is reported after abdominal pelvic floor surgery with mesh implants for pelvic organ prolapse.