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

Structured Abstract Background Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse. Objective 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 two common transvaginal prolapse repairs, uterosacral ligament and sacrospinous ligament vaginal vault suspension. Study Design This planned secondary analysis of a 2x2 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 SF-36 was completed at baseline, 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 ± standard error) 2.24 + 0.23 and 2.76 + 0.25; both increased slightly from baseline at 2 weeks (+0.65, p 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 stage 2-4 pelvic organ prolapse. On average, immediate postoperative pain is low and improves to below baseline levels by 4-6 weeks.