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.
To compare outcomes after vaginal reconstructive surgery between women with and without preoperative pelvic pain.
Baseline and postoperative data were analyzed from the Outcomes Following Vaginal Prolapse Repair and Midurethral Sling (OPUS) multicenter trial. The trial involved women with anterior prolapse without symptoms of stress incontinence randomized to receive either a midurethral sling or sham incisions during surgery. Participants completed the visual analogue pain scale adapted for suprapubic pain (VAS) and Pelvic Floor Distress Inventory (PFDI) questionnaire at baseline, 3 months, and 12 months. Preoperative pelvic pain was defined as a response of “5” or greater on pain VAS or answering “moderately” or “quite a bit” on the PFDI 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.
OPUS 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=0.004). Women who had sham incisions and pelvic pain were more likely of Hispanic ethnicity than those women without pelvic pain (27.8% vs 9.4%; p=0.002). Patient improvement based on the Patient Global Impression of Improvement did not differ between arms. Women with pelvic pain had greater improvement on pain VAS scores post-surgery at 3 months (-3.1±2.9 vs -0.4±1.6, p<0.001) and at 12 months (-3.4±3.0 vs -0.6±1.6, p<0.001) compared to those without pain, although their pain scores remained higher than those without preoperative pelvic pain at all time-points (p<0.001, all). Similar improvements were found on the PFDI and pelvic floor impact questionnaires. 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 groups.
Women with preoperative pelvic pain experience significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery, and have similar subjective improvement postoperatively compared to women without preoperative pelvic pain. Reassuringly, performance of a midurethral sling did not appear to impact these results.

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