Postoperative pain outcomes after transvaginal mesh revision

Abstract

Introduction and hypothesis Although the current literature discusses mesh complications including pain, as well as suggesting different techniques for removing mesh, there is little literature regarding pain outcomes after surgical removal or revision. The purpose of this study is to determine if surgical removal or revision of vaginal mesh improves patient’s subjective complaints of pelvic pain associated with original placement of mesh. Methods After obtaining approval from the Vanderbilt University Medical Center Institutional Review Board, a retrospective review of female patients with pain secondary to previous mesh placement who underwent excision or revision of vaginal mesh from January 2000 to August 2012 was performed. Patient age, relevant medical history including menopause status, previous hysterectomy, smoking status, and presence of diabetes, fibromyalgia, interstitial cystitis, and chronic pelvic pain, was obtained. Patients’ postoperative pain complaints were assessed. Results Of the 481 patients who underwent surgery for mesh revision, removal or urethrolysis, 233 patients met our inclusion criteria. One hundred and sixty-nine patients (73 %) reported that their pain improved, 19 (8 %) reported that their pain worsened, and 45 (19 %) reported that their pain remained unchanged after surgery. Prior history of chronic pelvic pain was associated with increased risk of failure of the procedure to relieve pain (OR 0.28, 95 % CI 0.12–0.64, p=0.003). Conclusions Excision or revision of vaginal mesh appears to be effective in improving patients’ pain symptoms most of the time. Patients with a history of chronic pelvic pain are at an increased risk of no improvement or of worsening pain.

Evaluation and Management of Mid-Urethral Sling Complications

“…A study by Danford et al evaluated the post-operative pain of 233 patients who were undergoing a mesh excision for the indication of pelvic pain after a MUS. The study found that 73 % of patients reported improvement in their pain, with 18 % reporting worsening of their pain, and 19 % reporting the pelvic pain was unchanged post-operatively [41]. Hou et al found similar results in patients who presented with pelvic pain after a MUS.…”

Pelvic Floor and Urinary Distress in Women with Fibromyalgia

“…Additionally, women with FM are more likely to have had a hysterectomy compared with the general population, yet hysterectomy may not improve chronic pelvic pain in women with FM (Pamuk, Donmez, & Cakir, 2009; Santoro, Cronan, Adams, & Kothari, 2012; ter Borg, Gerards-Rociu, Haanen, & Westers, 1999). Similarly patients with chronic pelvic pain compared with those without recently were found to be at increased risk of not improving or even worsening after undergoing transvaginal mesh revision (Danford, Osborn, Reynolds, Biller, & Dmochowski, 2015). …”

Indications and risk factors for midurethral sling revision

“…In addition, studies that have evaluated risk factors for needing revision surgery have kept their scope small and have not studied all possible factors. While there are published studies that report on outcomes after revision surgery for vaginal mesh complications [8][9][10][11], there are only a few studies that have focused on the indications and risk factors for needing sling revision surgery specifically [12,13]. Therefore, the primary objective of this study was to determine the indications and risk factors for needing midurethral sling revision in a large cohort of women undergoing midurethral sling placement at a tertiary care center.…”