[Postoperative pain after transvaginal repair of pelvic organ prolapse with or without mesh]

Abstract

Objective: To assess postoperative pain after POP surgery by vaginal approach with and without mesh.

Patients and methods: One hundred and thirty-two consecutives patients operated on for POP (POP-Q ≥ 2) were enrolled. Surgical procedure was a traditional repair without mesh in 66 women and a mesh repair (Prolift) in 66 women. Postoperative pain was prospectively assessed by autoadministred questionnaires including analog visual scale. Pain scores were recorded 1 day after surgery (D1), at discharge, at 1 month follow-up (M1) and at 3 to 6 months follow-up (M3-6). We focused specially on mesh repair, age, previous prolapse procedure, hysterectomy, sacrospinofixation, transobturator sling, pre- and postoperative POP-Q score.

Results: At discharge, pain score was significantly higher in the mesh group (1.2 ± 1.8 versus 0.5 ± 0.9, P=0.021). Pain score were low (VAS<3) and similar in the two groups with or without mesh at M1 and M3-6 follow-up. When focusing on associated factors, hysterectomy as a significant higher pain score at day 1, transobturator slings associated to traditional repair are more painful at D1 versus associated to mesh repair, sacrospinofixation has only a statistical tendency (P=0.08) more painful at D1.

Discussion and conclusion: Pain score are low after both traditional or mesh repair by vaginal route. Mesh repair, hysterectomy and sacrospinofixation are more painful only in the first days after surgery. Our study supports the theory that transvaginal mesh procedure allows a quick return to normal life.