Background

Pelvic pain is a debilitating condition that is common among women with pelvic floor disorders. Limited information is known about the impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery.

Objective

This study aimed to compare the outcomes after vaginal reconstructive surgery between women with and without preoperative pelvic pain.

Study Design

Baseline and postoperative data were analyzed from the “Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial.” The multicenter trial involved women with anterior prolapse without symptoms of stress incontinence randomized to receive either a midurethral sling or sham incisions during a vaginal reconstructive surgery. Participants completed the visual analog scale adapted for suprapubic pain and Pelvic Floor Distress Inventory at baseline, 3 months, and 12 months. Preoperative pelvic pain was defined as a response of “5” or greater on pain on the visual analog scale or answering “moderately” or “quite a bit” on the Pelvic Floor Distress Inventory question, “Do you usually experience pain in the lower abdomen or genital area?” Outcomes and complication rates were compared between women with and without pelvic pain.

Results

The “Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial” participants included 112 women with pelvic pain (58 had a midurethral sling and 54 had sham incisions) and 212 women without pelvic pain (105 had a midurethral sling and 107 had sham incisions). Women who had a midurethral sling and pelvic pain were younger than women without pelvic pain (60.3±12.1 vs 65.1±8.6; P=.004). Women who had sham incisions and pelvic pain were more likely of Hispanic ethnicity than women without pelvic pain (27.8% vs 9.4%; P=.002). Patient improvement based on the Patient Global Impression of Improvement scale did not differ between arms. Women with pelvic pain had greater improvement on the visual analog scale pain scores after a surgical procedure at 3 months (−3.1±2.9 vs −0.4±1.6; P<.001) and at 12 months (−3.4±3.0 vs −0.6±1.6; P<.001) than women without pain, although their pain scores remained higher than those without preoperative pelvic pain at all time points (P<.001 for all). Similar improvements were found on the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. The differences observed were not affected by whether women were in the midurethral sling or sham arm of the trial. Postoperative urinary tract infection and incomplete bladder emptying did not differ between the groups.

Conclusion

Women with preoperative pelvic pain experienced significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery and had similar subjective improvement postoperatively compared with women without preoperative pelvic pain. Reassuringly, the performance of a midurethral sling did not have an impact on the results.

中文翻译：

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术前盆腔疼痛对阴道重建术后预后的影响

背景

骨盆疼痛是一种使人衰弱的疾病，在患有骨盆底疾病的女性中很常见。关于术前盆腔疼痛对阴道重建手术后结果的影响，了解的信息有限。

客观的

本研究旨在比较术前有盆腔痛和无盆腔痛的女性进行阴道重建手术后的结果。

学习规划

从“阴道脱垂修复和中尿道吊带试验后的结果”中分析了基线和术后数据。多中心试验纳入了无压力性尿失禁症状的前部脱垂女性，她们在阴道重建手术期间随机接受中尿道吊带或假切口。参与者在基线、3 个月和 12 个月时完成了适用于耻骨上疼痛和盆底窘迫量表的视觉模拟量表。术前盆腔疼痛被定义为在视觉模拟量表上对疼痛的反应为“5”或更高，或者在骨盆底窘迫量表问题中回答“中等”或“相当多”，“您是否经常感到下腹部疼痛？还是生殖器部位？” 比较了有和没有骨盆疼痛的女性的结果和并发症发生率。

结果

“阴道脱垂修复和中尿道吊带试验后的结果”参与者包括 112 名有骨盆疼痛的女性（58 名有中段尿道吊带，54 名有假切口）和 212 名没有骨盆疼痛的女性（105 名有中段尿道吊带，107 名有假切口）。有尿道中段吊带和骨盆疼痛的女性比没有骨盆疼痛的女性年轻（60.3±12.1 vs 65.1±8.6；P = .004）。有假手术切口和骨盆疼痛的女性比没有骨盆疼痛的女性更有可能是西班牙裔（27.8% vs 9.4%；P=.002）。基于患者总体改善印象量表的患者改善在两组之间没有差异。在手术后 3 个月（-3.1±2.9 对 -0.4±1.6；P <.001）和 12 个月（-3.4±3.0 对 -0.6± 1.6; P <.001）比没有疼痛的女性，尽管她们的疼痛评分在所有时间点都高于没有术前盆腔疼痛的女性（P<.001 所有）。在骨盆底窘迫量表和骨盆底影响问卷中发现了类似的改进。观察到的差异不受女性是否处于试验的中尿道吊带或假臂的影响。两组术后尿路感染和膀胱排空不完全没有差异。

结论

与术前没有盆腔疼痛的女性相比，术前盆腔疼痛的女性在接受阴道重建手术后疼痛和盆底症状有显着改善，术后主观改善也相似。令人欣慰的是，尿道中段吊带的性能对结果没有影响。