Kato Kumiko, Suzuki Shoji, Kawanishi Hideji, Matsui Hirotaka, Nagayama Jun, Sano Tomoyasu, Hirabayashi Hiroki, Yamamoto Shigeki, Suzuki Koichi, Hattori Ryohei
Department of Female Urology, Japanese Red Cross Nagoya First Hospital.
Department of Urology, Japanese Red Cross Nagoya First Hospital.
Nihon Hinyokika Gakkai Zasshi. 2018;109(2):90-95. doi: 10.5980/jpnjurol.109.90.
(Objective) A FDA alert in 2011 warned about postoperative chronic pain following transvaginal mesh (TVM) for pelvic organ prolapse (POP). We studied cases with chronic pain after TVM, natural tissue repair (NTR) and laparoscopic salcocopopexy (LSC). (Methods) We retrospectively reviewed medical charts of patients who underwent POP operations in our hospital or were referred to us after POP operations in other hospitals between 2006 and 2016. Postoperative chronic pain was defined as persistent pain for more than three months following the first three months from the time of POP operations.Patients' characteristics and treatments were analyzed. (Results) In patients who underwent POP operations in our hospital, the rates of chronic postoperative pain after TVM, NTR and LSC were 12/2,457 (0.49%), 1/402 (0.26%) and 0/29 (0%), respectively. Another 8 patients were referred to us after POP operations in other hospitals. Thus, a total of 21 patients (15: TVM, 6: NTR) had either medications, surgical treatment or were referred to other doctors due to postoperative chronic pain. All of them were parous women aged 53 to 81 years old. Preoperative chronic pelvic pain was found in seven patients (33%), and another four patients (19%) had orthopedic diseases with chronic pain. The main locations of pain were; vagina 11, vulva 2, urinary bladder 2, urethra 1, coccyx 1, buttocks 1, anus 1, perineum 1 and groin 1. Nineteen patients had pharmacological treatment using tricyclic antidepressants, Ca channel αδ ligand and/or serotonin-noradrenalin reuptake inhibitor (SNRI); 9 (47%) of the patients showed a notable improvement. Three patients following TVM had surgical treatment; one with bladder mesh exposure was resolved with TURis, one with vaginal mesh exposure was resolved with mesh trimming, but one with tenderness on the mesh arm did not improve after a partial mesh removal. Four patients were referred to pain clinics. (Conclusions) Postoperative chronic pain can occur following both TVM and NTR therefore, attentive listening and proper medication are important as initial therapies. It is mandatory to examine the presence of mesh exposure in patients after using mesh. We should be careful about preoperative chronic pain, pelvic or elsewhere, as a risk factor for postoperative chronic pain.
（目的）2011年美国食品药品监督管理局（FDA）发出警报，警告经阴道网片（TVM）治疗盆腔器官脱垂（POP）后会出现术后慢性疼痛。我们研究了TVM、天然组织修复（NTR）和腹腔镜骶棘韧带固定术（LSC）后出现慢性疼痛的病例。（方法）我们回顾性分析了2006年至2016年期间在我院接受POP手术或在其他医院接受POP手术后转诊至我院的患者的病历。术后慢性疼痛定义为POP手术后前三个月后的持续疼痛超过三个月。分析患者的特征和治疗情况。（结果）在我院接受POP手术的患者中，TVM、NTR和LSC术后慢性疼痛的发生率分别为12/2457（0.49%）、1/402（0.26%）和0/29（0%）。另外8例患者在其他医院接受POP手术后转诊至我院。因此，共有21例患者（15例TVM，6例NTR）因术后慢性疼痛接受了药物治疗、手术治疗或转诊至其他医生处。所有患者均为经产妇，年龄在53至81岁之间。7例患者（33%）术前存在慢性盆腔疼痛，另外4例患者（19%）患有慢性疼痛的骨科疾病。疼痛的主要部位为：阴道11处、外阴2处、膀胱2处、尿道1处、尾骨1处、臀部1处、肛门1处、会阴1处和腹股沟1处。19例患者使用三环类抗抑郁药、钙通道αδ配体和/或5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI）进行药物治疗；9例（47%）患者有显著改善。3例TVM术后患者接受了手术治疗；1例膀胱网片暴露患者经经尿道膀胱肿瘤电切术（TURis）治愈，1例阴道网片暴露患者经网片修剪治愈，但1例网片臂压痛患者在部分网片切除后未改善。4例患者转诊至疼痛门诊。（结论）TVM和NTR术后均可能发生慢性疼痛，因此，仔细倾听和适当用药作为初始治疗很重要。使用网片后必须检查患者是否存在网片暴露。我们应注意术前慢性疼痛，无论是盆腔还是其他部位，作为术后慢性疼痛的危险因素。
