Jong Karen, Popat Shreeya, Christie Alana, Zimmern Philippe E
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9110, USA.
Int Urogynecol J. 2018 Jun;29(6):859-864. doi: 10.1007/s00192-017-3413-5. Epub 2017 Jul 10.
This study was to review our experience of pain relief durability in women who experienced initial pain resolution after vaginal mesh and/or sling removal (VMSR).
A retrospective chart review of consecutive, nonneurogenic women who underwent VMSR for pain and reported persistent pain relief at the 6-month postoperative follow-up visit were assessed. Pre- and postoperative data collected were self-reported chief complaints, physical examination, other medical conditions associated with chronic pain, use of pain medications, Urogenital Distress Inventory-6 (in which question 6 specifically addresses pain), and the Numerical Pain Rating Scale (NPRS). Success was defined by continued resolution of pain assessed by score of 0 on NPRS (0 none to 10 terrible), (0-1 on the Urogenital Distress Inventory-6 (UDI-6) question 6, subjective report of pain-free status, and/or no chronic use of pain medications other than those prescribed for non-mesh-related pain.
Between 2006 and 2015, 125 of 356 women met study criteria. Mean follow-up after VMSR was 3.5 (range 0.5-10) years. Among 25 women who did not meet success criteria by questionnaire answers or subjective report, 21 had causes unrelated to their original mesh/sling placement and were pain free after they were addressed. Four women experienced delayed mesh-related pain return at 28, 46, 47, and 54 months, respectively; two required mesh removal surgery. Involvement in lawsuits and chronic pain-related medical conditions did not affect the durability of pain relief.
At a mean follow-up of 3.5 years, the original pain relief noted after VMSR was durably maintained.
本研究旨在回顾我们在接受阴道网片和/或吊带移除术（VMSR）后最初疼痛得到缓解的女性中，疼痛缓解持续性方面的经验。
对连续的非神经源性女性进行回顾性病历审查，这些女性因疼痛接受了VMSR，并在术后6个月随访时报告疼痛持续缓解。收集的术前和术后数据包括自我报告的主要症状、体格检查、与慢性疼痛相关的其他医疗状况、止痛药物的使用、泌尿生殖系统困扰量表-6（其中问题6专门针对疼痛）以及数字疼痛评分量表（NPRS）。成功的定义为通过NPRS评分为0（0表示无疼痛至10表示剧痛）、泌尿生殖系统困扰量表-6（UDI-6）问题6评分为0 - 1、主观报告无痛状态以及/或者除了因非网片相关疼痛而开具的药物外无长期使用止痛药物来评估疼痛持续缓解。
在2006年至2015年期间，356名女性中有125名符合研究标准。VMSR后的平均随访时间为3.5年（范围0.5 - 10年）。在25名未通过问卷答案或主观报告达到成功标准的女性中，21名的疼痛原因与其最初的网片/吊带放置无关，在这些原因得到解决后她们不再疼痛。4名女性分别在术后28、46、47和54个月出现与网片相关的疼痛延迟复发；其中2名需要再次进行网片移除手术。参与诉讼和与慢性疼痛相关的医疗状况并不影响疼痛缓解的持续性。
在平均3.5年的随访中，VMSR后最初观察到的疼痛缓解得到了持久维持。
