Chronic pain syndrome after pelvic floor reconstruction

• Anzhella R. Molokanova
• Al’fiya G. Yaschuk
• Il’nur I. Musin
• Dina F. Absalyamova
• Liliana A. Dautova

Abstract

The aim of the study was to choose the most optimal method of surgical treatment of anterior apical prolapse of the pelvic organs.

Material and methods. A retrospective analysis of case reports in period from 2016 to 2019 was carried out in order to identify complications in form of chronic pain syndrome after surgical correction of genital prolapse. At the second stage of a prospective study, surgical treatment of 48 women with anterior apical prolapse was performed.

Results. The conducted vNOTES (vaginal natural orifice transluminal endoscopic surgery procedure) showed the most favorable results in comparison with the sacral-spinal fixation of the vaginal stump in the postoperative period.

Conclusion. Search for a preferred method of surgical treatment in order to reduce traumatization of pelvic structures is relevant, taking into account refusal of European communities from previously accepted gold standard treatment in genital prolapse surgery. Thus, it can be assumed that vNOTES is the first line of surgical correction of anterior apical prolapse of the pelvic organs.

Keywords:chronic pelvic pain; transvaginal surgery; pelvic organ prolapse; transluminal surgery

References

1. Maher C., Feiner B., Baessier K., et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2007; 3: CD004014. DOI: https://doi.org/10.1002/14651858.CD004014.pub5

2. Diwadkar G.B., Barber M.D., Feiner B., et al. Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol. 2009; 113: 367. DOI: https://doi.org/10.1097/AOG.0b013e318195888d

3. Reynolds W.S., Gold K.P., Kauffman M.R., et al. Immediate effects of the initial FDA notification on the use of surgical mesh for pelvic organ prolapse surgery in medicare beneficiaries. Neurourol Urodyn. 2013; 32: 330–5. DOI: https://doi.org/10.1002/nau.22318

4. Committee on Gynecologic Practice. Committee Opinion No. 513: vaginal placement of synthetic mesh for pelvic organ prolapse. Obstet Gynecol. 2011; 118: 1459–64. DOI: https://doi.org/10.1097/AOG.0b013e31823ed1d9

5. Welk B., Al-Hothi H., Winick-Ng J. Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence. JAMA Surg. 2015; 150: 1167–75. DOI: https://doi.org/10.1001/jamasurg.2015.2590

6. Younger A., Rac G., Clemens J.Q., et al. Pelvic organ prolapse surgery in academic female pelvic medicine and reconstructive surgery urology practice in the setting of the Food and Drug Administration Public Health Notifications. Urology. 2016; 91: 46–51. DOI: https://doi.org/10.1016/j.urology.2015.12.057

7. Rogo-Gupta L., Castellanos M. When and how to excise vaginal mesh. Curr Opin Obstet Gynecol. 2016; 28 (4): 311–5. DOI: https://doi.org/10.1097/GCO.0000000000000292

8. Rigaud J., Pothin P., Labat J.-J., et al. Functional results after tape removal for chronic pelvic pain following tension-free vaginal tape or transobturator tape. J Urol. 2010; 184 (2): 610–5. DOI: https://doi.org/10.1016/j.juro.2010.03.132

9. Buechel M., Tarr M.E., Walters M.D. Vaginal apical pain after sacrocolpopexy in absence of vaginal mesh erosion: a case series. Female Pelvic Med Reconstr Surg; 2016; 22 (1): e8–10. DOI: https://doi.org/10.1097/SPV.0000000000000218

10. Hou J.C., Alhalabi F., Lemack G.E., et al. Outcome of transvaginal mesh and tape removed for pain only. J Urol. 2014; 192 (3): 856–60. DOI: https://doi.org/10.1016/j.juro.2014.04.006

11. Miklos J.R., Chinthakanan O., Moore R.D., et al. Indications and complications associated with the removal of 506 pieces of vaginal mesh used in pelvic floor reconstruction: a multicenter study. Surg Technol Int. 2016; 29: 185–9.

12. Marcus-Braun N., Bourret A., von Theobald P. Persistent pelvic pain following transvaginal mesh surgery: a cause for mesh removal. Eur J Obstet Gynecol Reprod Biol. 2012; 162: 224–8. DOI: https://doi.org/10.1016/j.ejogrb.2012.03.002

13. Toozs-Hobson P., Cardozo L., Hillard T. Managing pain after synthetic mesh implants in pelvic surgery. Eur J Obstet Gynecol Reprod Biol. 2019; 234: 49–52. DOI: https://doi.org/10.1016/j.ejogrb.2018.12.037

14. De Gracia S, de Tayrac R. Beware of preoperative pain before implanting a mesh in pelvic floor reconstructive surgery. BJOG. 2021; 128 (12): 2044–5. DOI: https://doi.org/10.1111/1471-0528.16831

15. Costello C.R., Bachman S.L., Grant S.A., et al. Characterization of heavy weight and light weight polypropylene prosthetic mesh explants from a single patient. Surg Innov 2007; 14 (3): 168–76. DOI: https://doi.org/10.1177/1553350607306356

16. Agur A.M., Dalley A.F. Grant’s atlas of anatomy. Philadelphia: Lippincott Williams and Wilkins, 2009.

17. Zimmern P.E., Chapple C.C., Haab F., et al. Vaginal surgery for incontinence and prolapse. Berlin, London: Springer, 2006.

18. Bekker M.D., Hogewoning C.R., Wallner C., et al. The somatic and autonomic innervation of the clitoris; preliminary evidence of sexual dysfunction after minimally invasive slings. J Sex Med 2012; 9 (6): 1566–78. DOI: https://doi.org/10.1111/j.1743-6109.2012.02711.x

19. Achtari C., McKenzie B.J., Hiscock R., et al. Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17: 330–4. DOI: https://doi.org/10.1007/s00192-005-0004-7

20. Campbell F., Collett B.J. Chronic pelvic pain. Br J Anaesth. 1994; 73: 571–3. DOI: https://doi.org/10.1093/bja/73.5.571

21. Cholhan H.J., Hutchings T.B., Rooney K.E. Dyspareunia associated with paraurethral banding in the transobturator sling. Am J Obstet Gynecol. 2010; 202 (5): 481. DOI: https://doi.org/10.1016/j.ajog.2010.01.061

22. Klosterhalfen B., Junge K., Klinge U. The lightweight and large porous mesh concept for hernia repair. Expert Rev Med Devices. 2005; 2 (1): 103–17. DOI: https://doi.org/10.1586/17434440.2.1.103

23. Lee D., Chang J., Zimmern P.E. Iatrogenic pelvic pain: surgical and mesh complications. Phys Med Rehabil Clin N Am. 2017; 28 (3): 603–19. DOI: https://doi.org/10.1016/j.pmr.2017.03.010

24. Blau E.K., Adelstein S.A., Amin K.A., et al. Tobacco use, immunosuppressive, chronic pain, and psychiatric conditions are prevalent in women with symptomatic mesh complications undergoing mesh removal surgery. Investig Clin Urol. 2020; 61 (suppl 1): S57–63. DOI: https://doi.org/10.4111/icu.2020.61.S1.S57

25. Boureau F., Luu M., Doubrere J.F. Qualitative and quantitative study of a French pain McGill adapted questionnaire in experimental and clinical conditions. Pain. 1984; 21 (suppl 2): 422.

26. Cherny N.I., Thaler H.T., Friedlander-Klar H., et al. Opioid responsiveness of cancer pain syndromes caused by neuropathic or nociceptive mechanisms: a combined analysis of controlled, single-dose studies. Neurology. 1994; 44 (5): 857–61. DOI: https://doi.org/10.1212/wnl.44.5.857

27. Mystakidou K., Parpa E., Tsilika E., et al. Comparison of pain quality descriptors in cancer patients with nociceptive and neuropathic pain. In Vivo. 2007; 21 (1): 93–7.

28. Manning J.A., Arnold P. A review of six sacrospinous suture devices. Aust N Z J Obstet Gynaecol. 2014; 54 (6): 558–63. DOI: https://doi.org/10.1111/ajo.12272

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