Incidence and risk factors for pelvic pain following mesh implant surgery for the treatment of pelvic floor disorders

Our aim was to assess incidence and risk factors for pelvic pain after pelvic mesh implantation.

This is a retrospective study of women with no baseline pelvic pain who underwent surgery with mesh implant for the treatment of prolapse and/or incontinence at least one year prior to study period.

Classification: Canadian Task Force Level II-2 SETTING: Single university hospital PATIENTS: Women who have undergone surgery with pelvic mesh implant for treatment of pelvic floor disorders including prolapse and incontinence INTERVENTIONS: Telephone interviews to assess pain, sexual function and general health.

Pain was measured by McGill Short-Form Pain Questionnaire for somatic pain, Neuropathic Pain Symptom Inventory for neuropathic pain, Pennebaker Inventory of Limbic Languidness for somatization, and Female Sexual Function Index for sexual health and dyspareunia. General health was assessed with SF-12.

Among 160 women enrolled, mean time since surgery was 20.8±10.5 months, with mean age 62.1±11.2 years, 93.8% Caucasian, 86.3% post-menopausal, 3.1% tobacco users. Types of mesh included midurethral sling for stress incontinence (78.8%), abdominal/robotic sacrocolpopexy (35.7%), transvaginal for prolapse (6.3%), and peri-rectal for fecal incontinence (1.9%), with 23.8% concomitant mesh implants for both prolapse and incontinence. Our main outcome, self-reported pelvic pain at least one year after surgery, was 15.6%. Women reporting pain were younger, with fibromyalgia, worse physical health, higher somatization, and lower surgery satisfaction (all p<.05). Current pelvic pain correlated with early post-operative pelvic pain (p<.001), fibromyalgia (p=.002), worse physical health (p=.003) and somatization (p=.003). Sexual function was suboptimal (mean FSFI 16.2±12.1). Only 54.0% were sexually active, with 19.0% of those reporting dyspareunia.

One in six women reported de novo pelvic pain after pelvic mesh implant surgery, with decreased sexual function. Risk factors included younger age, fibromyalgia, early post-operative pain, poorer physical health, and somatization. Understanding risk factors for pelvic pain after mesh implantation may improve patient selection.

Journal of minimally invasive gynecology. 2016 Oct 20 [Epub ahead of print]

Elizabeth J Geller, Emma Babb, Andrea G Nackley, Denniz Zolnoun

Division of Female Pelvic Medicine and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. Electronic address: ., School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Center for Pain Research and Innovation, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

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