The Association Between Pelvic Organ Prolapse, Pelvic Pain and Pelvic Reconstructive Surgery Using Transvaginal Mesh: A Secondary Analysis of a Prospective Multicenter Observational Cohort Trial

Abstract

Background: The aims of the study were to examine the type, severity and prevalence of pain in women with pelvic organ prolapse (POP) before and after pelvic floor reconstructive surgery, and to evaluate the effect of POP reconstruction over a period of 2 years.

Methods: The study data were collected in a past multicenter prospective study (Propel-Study; Clinical Trials.Cov. Identifier: NCT00638235), where a total of 281 women with stage 2-4 symptomatic POP underwent prolapse repair using the transvaginal, single-incisionElevate technique for anterior/apical and posterior/apical prolapse. The degree of POP repair during a follow-up of 2 years was the primary endpoint of the study and has already evaluated previously. In the Propel trial subjective assessments of presumable POP symptoms before and 6, 12 and 24 months after surgery were registered too utilizing the pelvic floor disorder inventory (PFDI) questionnaire. The investigation of all or specific domains of PFDI symptoms were declared as secondary objectives of that study. The present treatise is concentrated on the evaluation of the PFDI pain symptoms consisting of six questions for describing different types of pain.

Results: Preoperatively, 67% of all POP patients reported moderate-to-severe pain, mainly of visceral character. Pelvic floor reconstructive surgery resulted in significant cure or improvement in all pain types, intensities and locations, and these improvements were stable over 2 years. The largest reduction in pain symptoms following POP repair was registered for visceral complaints (87%), followed by the anterior (84%) and then the posterior (45%). Patients with cystocele had significantly more pain pre- and postoperatively than those with enterocele/rectocele. The best cure effects overall were achieved in cystocele patients with visceral or anterior pain (> 96%). No correlation was found between POP stage and pain intensity preoperatively. The best pain cure rates after surgery were obtained in patients with pronounced POP and pain in the visceral and anterior areas (> 93%). Surgically induced de novo pain improved with time from 16% (6 months) to 11% (12 months) and then 7% (24 months).

Conclusion: POP of stage 2 and greater can be associated with moderate-to-severe pain, which can be improved and cured by mesh-supported prolapse repair. Postoperative de novo pain does occur, although its incidence and severity appear to be reduced over time.

J Clin Gynecol Obstet. 2020;9(4):79-95
doi: https://doi.org/10.14740/jcgo696