Pain after permanent versus delayed absorbable monofilament suture for vaginal graft attachment during minimally invasive total hysterectomy and sacrocolpopexy

C. Emi Bretschneider*, Kimberly Kenton, Elizabeth J. Geller, Jennifer M. Wu, Catherine A. Matthews

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The objective was to evaluate pain and dyspareunia in women undergoing minimally invasive total hysterectomy and sacrocolpopexy (TLH + SCP) with a light-weight polypropylene mesh 1 year after surgery. Methods: This is a planned secondary analysis of a randomized trial comparing permanent (Gore-Tex) versus absorbable suture (PDS) for vaginal attachment of a y-mesh (Upsylon™) during TLH + SCP in women with stage ≥II prolapse. Patient data were collected at baseline and 1 year after surgery. Our primary outcome was patient-reported pain or dyspareunia at 1 year. Results: Two hundred subjects (Gore-Tex n = 99, PDS n = 101) were randomized and underwent surgery. Overall, the mean age ± SD was 60 ± 10 years, and BMI was 27 ± 5 kg/m2. The majority were white (89%), menopausal (77%), and had stage III/IV (63%) prolapse. 93% completed a 1-year follow-up and are included in this analysis (Gor-Tex n = 95, PDS n = 90). The overall rate of participants who reported pain at 1 year was 20%. Of those who did not report any pain at baseline, 23% reported de novo dyspareunia, 4% reported de novo pain, and 3% reported both at 1 year. Of participants who reported pain or dyspareunia at baseline prior to surgery, 66% reported resolution of their symptoms at 1 year. There were no differences in most characteristics, including mesh/suture exposure (7% vs 5%, p = 0.56) between patients who did and did not report any pain at 1 year. On multiple logistic regression controlling for age, baseline dyspareunia, and baseline pain, baseline dyspareunia was associated with a nearly 4-fold increased odds of reporting any pain at 1 year (OR 3.8, 95%CI 1.7–8.9). Conclusions: The majority of women report resolution of pain 1 year following TLH + SCP with a low rate of de novo pain.

Original languageEnglish (US)
Pages (from-to)2035-2041
Number of pages7
JournalInternational Urogynecology Journal
Volume31
Issue number10
DOIs
StatePublished - Oct 1 2020

Keywords

  • Hysterectomy
  • Minimally invasive surgery
  • Pain
  • Pelvic organ prolapse
  • Postoperative complications

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology

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