Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence

Barber, Matthew D.; Brubaker, Linda; Nygaard, Ingrid; Wai, Clifford Y.; Dyer, Keisha Y.; Ellington, David R.; Sridhar, Amaanti; Gantz, Marie G.; Dickersin, Kay; Jiang, Luohua; Lavender, Missy; O’Dell, Kate M.; Ryan, Kate; Kong, Lan; McClish, Donna K.; Rickey, Leslie; Shade, David M.; Tuteja, Ashok K.; Yount, Susan

doi:10.1016/j.ajog.2019.06.004

Cited by 21 publications

(24 citation statements)

References 23 publications

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“…These increased (as expected) in the early postoperative period; however, by 3 months, they were significantly below baseline levels (all P<.001 in adjusted models), which suggests that the baseline pain present was related to POP and was relieved with POP surgery. 6 Furthermore, pain and general physical functioning (assessed in relevant generic health-related quality of life subscale scores) all significantly improved by 6 months after surgery compared with baseline, and these clinically meaningful improvements were maintained through 2 years. Results were similar in both surgical groups (except for greater buttock pain noted in the sacrospinous ligament suspension group in the early postoperative period), and only minor differences were seen based on randomization to pelvic muscle training vs usual care.…”

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confidence: 89%

“…The detailed postoperative investigation of pain and the long-term outcomes reported by Barber et al 6 in this study are an important contribution to the literature; the rigorous data collection methods and multicenter randomized trial design are strengths. Most pelvic surgeons and POP researchers are not familiar with the pain and functional activity patient-reported outcomes that were used, so the additional use in other gynecologic surgical populations would be helpful for the interpretation of these findings.…”

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confidence: 95%

“…2e5 Two articles in this month's Journal suggest that I reconsider my response about prolapse and pain or at least provide a more thoughtful answer in the future to this question! In a secondary analysis from the Pelvic Floor Disorders Network's Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, Barber et al 6 assessed pain and related outcomes after transvaginal native tissue prolapse repair. Meister et al 7 reported on pelvic floor myofascial pain in a clinic-based study of patients seeking care for pelvic floor disorder symptoms.…”

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confidence: 99%

“…First, the OPTIMAL trial randomly assigned women with Pelvic Organ Prolapse Quantification System stage II or greater POP and concurrent stress urinary incontinence first to perioperative behavioral therapy with pelvic muscle training vs usual care and then to uterosacral vs sacrospinous ligament suspension apical surgical repair with midurethral mesh sling. 6 Among data collected, the investigators included validated patient-reported instruments to assess pain and the ability to perform functional activities and generic healthrelated quality of life.…”

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confidence: 99%

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Prolapse, pain, and pelvic floor muscle dysfunction

Bradley

2019

American Journal of Obstetrics and Gynecology

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confidence: 89%

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confidence: 95%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Prolapse, pain, and pelvic floor muscle dysfunction

Bradley

2019

American Journal of Obstetrics and Gynecology

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“…Given that opioids are the mainstay of pain management for many clinical procedures, the period following an operation presents a vulnerable time in which patients may be more susceptible to excess opioid exposure. 6 Opioid use alone is associated with an increased risk of drug dependence, and other serious and life-threatening adverse events including overdose and respiratory depression. [7][8][9] Prolonged opioid use as well as increased morphine equivalent doses can further increase the risk of experiencing serious adverse events.…”

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confidence: 99%

Opioid prescribing and risks among commercially insured women undergoing pelvic organ prolapse repair

Gressler

dosReis

Chughtai

2021

Pharmacoepidemiology and Drug

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Purpose: Opioid use after surgical repair for pelvic organ prolapse (POP) is intended for short-term post-operative pain. This study compared the incidence of opioid prescribing in women undergoing POP transabdominal repair with mesh and transvaginal native tissue repair.Methods: A retrospective cohort of women undergoing POP transabdominal repair with mesh or transvaginal native tissue repair, was derived from a 10% random sample of enrollees from 2007 to 2015 within the IQVIA PharMetrics ® Plus Database.Primary outcomes were any prescription of opioids and cumulative days of opioids prescribed in the 14-180 days following surgical intervention. Inverse probability of treatment weights controlled for observed baseline confounders. Any opioid prescription was estimated using logistic regression and generalized linear regression for cumulative days of opioids prescribed. Results:The cohort of 49 052 women who underwent POP surgical repair included 46 813 women with transvaginal native tissue repair and 2239 women with transabdominal repair with mesh. Women with a transabdominal repair with mesh had a 1.19 (95%CI: 1.09-1.31) significantly higher odds of receiving an opioid prescription than women with transvaginal native tissue repair. Post-operatively, over 29% of women received opioid prescriptions. Mean cumulative days of post-surgical opioid prescribing was 32.2 (SD = 43.1), and was not statistically different between groups.Thirteen percent of women were prescribed opioids for 90 days or more.Conclusions: Women undergoing POP with transabdominal mesh are more likely to receive prescriptions for opioids after surgery compared to transvaginal native tissue repair. Treatment plans that address pain while mitigating the risks associated with prolonged opioid prescribing should be employed.bias analysis, long-term opioid use, native-tissue repair, pelvic organ prolapse, pharmacoepidemiology, post-operative opioid prescribing, transabdominal mesh | INTRODUCTIONPelvic organ prolapse (POP) is a prevalent condition that increases with age and affects about half of women worldwide. 1 Women diagnosed with POP are generally not in pain, but do suffer from pain-related symptoms including pelvic pressure and experience a decreased quality of life. 2,3 Nearly 1 in 10 women with POP undergo surgical treatment with a lifetime risk of surgery for POP in the United States of 11% by the eighth decade of life. 4 The surgical management options for POP include colporrhaphy or colpopexy (vaginal or sacrocolpopexy).

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Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

OuYang

Wang

et al. 2022

Clinical Anatomy

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Sacrospinous ligament fixation (SSLF) is one of the most used native tissue approaches for apical suspension with a high rate of perioperative complications. This study aimed to review cases undergoing a modified SSLF and assess its perioperative adverse events. It was a retrospective study of 168 consecutive patients undergoing modified transvaginal SSLF at a single tertiary center from 2017 to 2021. The sutures were placed on the sacrospinous ligament (SSL) approaching the sacrum through natural spaces under direct vision. Moreover, it was performed bilaterally. Patient demographics and perioperative complications were reviewed. The median age was 65 years, and 85.7% (144/168) had stage III–IV prolapse. Among the 168 patients undergoing this modified SSLF, 161 were for uterovaginal prolapse, and seven were for posthysterectomy vaginal vault prolapse. 83.9% (135/161) patients were concomitant with hysterectomy, and 70.2% (118/168) were with anteroposterior colporrhaphy. The median operation time was 82 min (interquartile range [IQR], 61–100 min), and the median intraoperative blood loss was 50 ml (IQR, 30–50 ml). Two cases had pelvic hematoma, and both were cured after expectant treatment. No patient required a homologous blood transfusion, and none complained about buttock or lower limb pain 2 weeks postoperatively. Nor did injury of the ureters, bladder, or rectum occur intraoperatively. This modified transvaginal SSLF procedure was safe and had no severe perioperative complications.

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Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence

Cited by 21 publications

References 23 publications

Prolapse, pain, and pelvic floor muscle dysfunction

Prolapse, pain, and pelvic floor muscle dysfunction

Opioid prescribing and risks among commercially insured women undergoing pelvic organ prolapse repair

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

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