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

NICHD Pelvic Floor Disorders Network

Research output: Contribution to journalArticle

Abstract

Background: Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse. Objective: The objectives of the study were to describe postoperative pain and functional activity after transvaginal native tissue reconstructive surgery with apical suspension and retropubic synthetic midurethral sling and to compare these outcomes between patients receiving 2 common transvaginal prolapse repairs, uterosacral ligament, and sacrospinous ligament vaginal vault suspension. Study Design: This planned secondary analysis of a 2 × 2 factorial randomized trial included 374 women randomized to receive uterosacral (n = 188) or sacrospinous (n = 186) vaginal vault suspension to treat both stages 2–4 apical vaginal prolapse and stress urinary incontinence between 2008 and 2013 at 9 medical centers. Participants were also randomized to receive perioperative pelvic muscle therapy or usual care. All patients received transvaginal native tissue repairs and a midurethral sling. Participants completed the Surgical Pain Scales (0–10 numeric rating scales; higher scores = greater pain) and Activity Assessment Scale (0–100; higher score = higher activity) prior to surgery and at 2 weeks, 4–6 weeks, and 3 months postoperatively. The MOS 36-item Short-Form Health Survey was completed at baseline and 6, 12, and 24 months after surgery; the bodily pain, physical functioning, and role–physical subscales were used for this analysis (higher scores = less disability). Self-reported pain medication use was also collected. RESULTS: Before surgery, average pain at rest and during normal activity were (adjusted mean ± SE) 2.24 ± 0.23 and 2.76 ± 0.25; both increased slightly from baseline at 2 weeks (+0.65, P =.004, and +0.74, P =.007, respectively) and then decreased below baseline at 3 months (–0.87 and –1.14, respectively, P <.001), with no differences between surgical groups. Pain during exercise/strenuous activity and worst pain decreased below baseline levels at 4–6 weeks (–1.26, P =.014, and –0.95, P =.002) and 3 months (–1.97 and –1.50, P <.001) without differences between surgical groups. Functional activity as measured by the Activity Assessment Scale improved from baseline at 4–6 weeks (+9.24, P <.001) and 3 months (+13.79, P <.001). The MOS 36-item Short-Form Health Survey Bodily Pain, Physical Functioning, and Role–Physical Scales demonstrated significant improvements from baseline at 6, 12, and 24 months (24 months: +5.62, +5.79, and +4.72, respectively, P <.001 for each) with no differences between groups. Use of narcotic pain medications was reported by 14.3% of participants prior to surgery and 53.7% at 2 and 26.1% at 4–6 weeks postoperatively; thereafter use was similar to baseline rates until 24 months when it decreased to 6.8%. Use of nonnarcotic pain medication was reported by 48.1% of participants prior to surgery, 68.7% at 2 weeks, and similar to baseline at 3 months; thereafter use dropped steadily to 26.6% at 2 years. Uterosacral ligament suspension resulted in less new or worsening buttock pain than sacrospinous suspension at 4–6 weeks postoperatively (4.6% vs 10.5%, P =.043) but no difference in groin or thigh pain. Conclusion: Pain and functional activity improve for up to 2 years after native tissue reconstructive surgery with uterosacral or sacrospinous vaginal vault suspension and midurethral sling for stages 2–4 pelvic organ prolapse. On average, immediate postoperative pain is low and improves to below baseline levels by 4–6 weeks.

Original languageEnglish (US)
Pages (from-to)233.e1-233.e16
JournalAmerican journal of obstetrics and gynecology
Volume221
Issue number3
DOIs
StatePublished - Sep 2019

Fingerprint

Reconstructive Surgical Procedures
Pelvic Organ Prolapse
Stress Urinary Incontinence
Pain
Suspensions
Suburethral Slings
Ligaments
Postoperative Pain
Health Surveys
Uterine Prolapse
Buttocks
Groin
Prolapse
Narcotics

Keywords

  • functional activity
  • pelvic floor disorders
  • pelvic organ prolapse
  • postoperative pain
  • sacrospinous ligament fixation
  • stress urinary incontinence
  • uterosacral ligament suspension
  • vaginal reconstructive surgery

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence. / NICHD Pelvic Floor Disorders Network.

In: American journal of obstetrics and gynecology, Vol. 221, No. 3, 09.2019, p. 233.e1-233.e16.

Research output: Contribution to journalArticle

@article{85ce7252013e4408b1659284bec032d5,
title = "Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence",
abstract = "Background: Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse. Objective: The objectives of the study were to describe postoperative pain and functional activity after transvaginal native tissue reconstructive surgery with apical suspension and retropubic synthetic midurethral sling and to compare these outcomes between patients receiving 2 common transvaginal prolapse repairs, uterosacral ligament, and sacrospinous ligament vaginal vault suspension. Study Design: This planned secondary analysis of a 2 × 2 factorial randomized trial included 374 women randomized to receive uterosacral (n = 188) or sacrospinous (n = 186) vaginal vault suspension to treat both stages 2–4 apical vaginal prolapse and stress urinary incontinence between 2008 and 2013 at 9 medical centers. Participants were also randomized to receive perioperative pelvic muscle therapy or usual care. All patients received transvaginal native tissue repairs and a midurethral sling. Participants completed the Surgical Pain Scales (0–10 numeric rating scales; higher scores = greater pain) and Activity Assessment Scale (0–100; higher score = higher activity) prior to surgery and at 2 weeks, 4–6 weeks, and 3 months postoperatively. The MOS 36-item Short-Form Health Survey was completed at baseline and 6, 12, and 24 months after surgery; the bodily pain, physical functioning, and role–physical subscales were used for this analysis (higher scores = less disability). Self-reported pain medication use was also collected. RESULTS: Before surgery, average pain at rest and during normal activity were (adjusted mean ± SE) 2.24 ± 0.23 and 2.76 ± 0.25; both increased slightly from baseline at 2 weeks (+0.65, P =.004, and +0.74, P =.007, respectively) and then decreased below baseline at 3 months (–0.87 and –1.14, respectively, P <.001), with no differences between surgical groups. Pain during exercise/strenuous activity and worst pain decreased below baseline levels at 4–6 weeks (–1.26, P =.014, and –0.95, P =.002) and 3 months (–1.97 and –1.50, P <.001) without differences between surgical groups. Functional activity as measured by the Activity Assessment Scale improved from baseline at 4–6 weeks (+9.24, P <.001) and 3 months (+13.79, P <.001). The MOS 36-item Short-Form Health Survey Bodily Pain, Physical Functioning, and Role–Physical Scales demonstrated significant improvements from baseline at 6, 12, and 24 months (24 months: +5.62, +5.79, and +4.72, respectively, P <.001 for each) with no differences between groups. Use of narcotic pain medications was reported by 14.3{\%} of participants prior to surgery and 53.7{\%} at 2 and 26.1{\%} at 4–6 weeks postoperatively; thereafter use was similar to baseline rates until 24 months when it decreased to 6.8{\%}. Use of nonnarcotic pain medication was reported by 48.1{\%} of participants prior to surgery, 68.7{\%} at 2 weeks, and similar to baseline at 3 months; thereafter use dropped steadily to 26.6{\%} at 2 years. Uterosacral ligament suspension resulted in less new or worsening buttock pain than sacrospinous suspension at 4–6 weeks postoperatively (4.6{\%} vs 10.5{\%}, P =.043) but no difference in groin or thigh pain. Conclusion: Pain and functional activity improve for up to 2 years after native tissue reconstructive surgery with uterosacral or sacrospinous vaginal vault suspension and midurethral sling for stages 2–4 pelvic organ prolapse. On average, immediate postoperative pain is low and improves to below baseline levels by 4–6 weeks.",
keywords = "functional activity, pelvic floor disorders, pelvic organ prolapse, postoperative pain, sacrospinous ligament fixation, stress urinary incontinence, uterosacral ligament suspension, vaginal reconstructive surgery",
author = "{NICHD Pelvic Floor Disorders Network} and Barber, {Matthew D.} and Linda Brubaker and Ingrid Nygaard and Wai, {Clifford Y.} and Dyer, {Keisha Y.} and David Ellington and Amaanti Sridhar and Gantz, {Marie G.} and Kay Dickersin and Luohua Jiang and Missy Lavender and Kate O'Dell and Kate Ryan and Paul Tulikangas and Lan Kong and Donna McClish and Leslie Rickey and David Shade and Ashok Tuteja and Susan Yount",
year = "2019",
month = "9",
doi = "10.1016/j.ajog.2019.06.004",
language = "English (US)",
volume = "221",
pages = "233.e1--233.e16",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
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number = "3",

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TY - JOUR

T1 - Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence

AU - NICHD Pelvic Floor Disorders Network

AU - Barber, Matthew D.

AU - Brubaker, Linda

AU - Nygaard, Ingrid

AU - Wai, Clifford Y.

AU - Dyer, Keisha Y.

AU - Ellington, David

AU - Sridhar, Amaanti

AU - Gantz, Marie G.

AU - Dickersin, Kay

AU - Jiang, Luohua

AU - Lavender, Missy

AU - O'Dell, Kate

AU - Ryan, Kate

AU - Tulikangas, Paul

AU - Kong, Lan

AU - McClish, Donna

AU - Rickey, Leslie

AU - Shade, David

AU - Tuteja, Ashok

AU - Yount, Susan

PY - 2019/9

Y1 - 2019/9

N2 - Background: Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse. Objective: The objectives of the study were to describe postoperative pain and functional activity after transvaginal native tissue reconstructive surgery with apical suspension and retropubic synthetic midurethral sling and to compare these outcomes between patients receiving 2 common transvaginal prolapse repairs, uterosacral ligament, and sacrospinous ligament vaginal vault suspension. Study Design: This planned secondary analysis of a 2 × 2 factorial randomized trial included 374 women randomized to receive uterosacral (n = 188) or sacrospinous (n = 186) vaginal vault suspension to treat both stages 2–4 apical vaginal prolapse and stress urinary incontinence between 2008 and 2013 at 9 medical centers. Participants were also randomized to receive perioperative pelvic muscle therapy or usual care. All patients received transvaginal native tissue repairs and a midurethral sling. Participants completed the Surgical Pain Scales (0–10 numeric rating scales; higher scores = greater pain) and Activity Assessment Scale (0–100; higher score = higher activity) prior to surgery and at 2 weeks, 4–6 weeks, and 3 months postoperatively. The MOS 36-item Short-Form Health Survey was completed at baseline and 6, 12, and 24 months after surgery; the bodily pain, physical functioning, and role–physical subscales were used for this analysis (higher scores = less disability). Self-reported pain medication use was also collected. RESULTS: Before surgery, average pain at rest and during normal activity were (adjusted mean ± SE) 2.24 ± 0.23 and 2.76 ± 0.25; both increased slightly from baseline at 2 weeks (+0.65, P =.004, and +0.74, P =.007, respectively) and then decreased below baseline at 3 months (–0.87 and –1.14, respectively, P <.001), with no differences between surgical groups. Pain during exercise/strenuous activity and worst pain decreased below baseline levels at 4–6 weeks (–1.26, P =.014, and –0.95, P =.002) and 3 months (–1.97 and –1.50, P <.001) without differences between surgical groups. Functional activity as measured by the Activity Assessment Scale improved from baseline at 4–6 weeks (+9.24, P <.001) and 3 months (+13.79, P <.001). The MOS 36-item Short-Form Health Survey Bodily Pain, Physical Functioning, and Role–Physical Scales demonstrated significant improvements from baseline at 6, 12, and 24 months (24 months: +5.62, +5.79, and +4.72, respectively, P <.001 for each) with no differences between groups. Use of narcotic pain medications was reported by 14.3% of participants prior to surgery and 53.7% at 2 and 26.1% at 4–6 weeks postoperatively; thereafter use was similar to baseline rates until 24 months when it decreased to 6.8%. Use of nonnarcotic pain medication was reported by 48.1% of participants prior to surgery, 68.7% at 2 weeks, and similar to baseline at 3 months; thereafter use dropped steadily to 26.6% at 2 years. Uterosacral ligament suspension resulted in less new or worsening buttock pain than sacrospinous suspension at 4–6 weeks postoperatively (4.6% vs 10.5%, P =.043) but no difference in groin or thigh pain. Conclusion: Pain and functional activity improve for up to 2 years after native tissue reconstructive surgery with uterosacral or sacrospinous vaginal vault suspension and midurethral sling for stages 2–4 pelvic organ prolapse. On average, immediate postoperative pain is low and improves to below baseline levels by 4–6 weeks.

AB - Background: Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse. Objective: The objectives of the study were to describe postoperative pain and functional activity after transvaginal native tissue reconstructive surgery with apical suspension and retropubic synthetic midurethral sling and to compare these outcomes between patients receiving 2 common transvaginal prolapse repairs, uterosacral ligament, and sacrospinous ligament vaginal vault suspension. Study Design: This planned secondary analysis of a 2 × 2 factorial randomized trial included 374 women randomized to receive uterosacral (n = 188) or sacrospinous (n = 186) vaginal vault suspension to treat both stages 2–4 apical vaginal prolapse and stress urinary incontinence between 2008 and 2013 at 9 medical centers. Participants were also randomized to receive perioperative pelvic muscle therapy or usual care. All patients received transvaginal native tissue repairs and a midurethral sling. Participants completed the Surgical Pain Scales (0–10 numeric rating scales; higher scores = greater pain) and Activity Assessment Scale (0–100; higher score = higher activity) prior to surgery and at 2 weeks, 4–6 weeks, and 3 months postoperatively. The MOS 36-item Short-Form Health Survey was completed at baseline and 6, 12, and 24 months after surgery; the bodily pain, physical functioning, and role–physical subscales were used for this analysis (higher scores = less disability). Self-reported pain medication use was also collected. RESULTS: Before surgery, average pain at rest and during normal activity were (adjusted mean ± SE) 2.24 ± 0.23 and 2.76 ± 0.25; both increased slightly from baseline at 2 weeks (+0.65, P =.004, and +0.74, P =.007, respectively) and then decreased below baseline at 3 months (–0.87 and –1.14, respectively, P <.001), with no differences between surgical groups. Pain during exercise/strenuous activity and worst pain decreased below baseline levels at 4–6 weeks (–1.26, P =.014, and –0.95, P =.002) and 3 months (–1.97 and –1.50, P <.001) without differences between surgical groups. Functional activity as measured by the Activity Assessment Scale improved from baseline at 4–6 weeks (+9.24, P <.001) and 3 months (+13.79, P <.001). The MOS 36-item Short-Form Health Survey Bodily Pain, Physical Functioning, and Role–Physical Scales demonstrated significant improvements from baseline at 6, 12, and 24 months (24 months: +5.62, +5.79, and +4.72, respectively, P <.001 for each) with no differences between groups. Use of narcotic pain medications was reported by 14.3% of participants prior to surgery and 53.7% at 2 and 26.1% at 4–6 weeks postoperatively; thereafter use was similar to baseline rates until 24 months when it decreased to 6.8%. Use of nonnarcotic pain medication was reported by 48.1% of participants prior to surgery, 68.7% at 2 weeks, and similar to baseline at 3 months; thereafter use dropped steadily to 26.6% at 2 years. Uterosacral ligament suspension resulted in less new or worsening buttock pain than sacrospinous suspension at 4–6 weeks postoperatively (4.6% vs 10.5%, P =.043) but no difference in groin or thigh pain. Conclusion: Pain and functional activity improve for up to 2 years after native tissue reconstructive surgery with uterosacral or sacrospinous vaginal vault suspension and midurethral sling for stages 2–4 pelvic organ prolapse. On average, immediate postoperative pain is low and improves to below baseline levels by 4–6 weeks.

KW - functional activity

KW - pelvic floor disorders

KW - pelvic organ prolapse

KW - postoperative pain

KW - sacrospinous ligament fixation

KW - stress urinary incontinence

KW - uterosacral ligament suspension

KW - vaginal reconstructive surgery

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U2 - 10.1016/j.ajog.2019.06.004

DO - 10.1016/j.ajog.2019.06.004

M3 - Article

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AN - SCOPUS:85071639396

VL - 221

SP - 233.e1-233.e16

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 3

ER -