Bretschneider C Emi, Myers Erinn, Geller Elizabeth G, Kenton Kimberly, Henley Barbara, Wu Jennifer M, Matthews Catherine A
From the Northwestern Feinstein School of Medicine, Chicago, IL.
Atrium Health, Charlotte, NC.
Urogynecology (Phila). 2023 Feb 1;29(2):144-150. doi: 10.1097/SPV.0000000000001266.
There are limited long-term data on patient-reported pain after surgical treatment of uterovaginal prolapse.
This study aimed to evaluate pain in women undergoing minimally invasive total hysterectomy and sacrocolpopexy with a lightweight polypropylene Y-mesh (Upsylon) >2 years after surgery.
This is a planned secondary analysis of a 5-site randomized trial comparing permanent versus absorbable suture for vaginal attachment of a lightweight polypropylene Y-mesh during total laparoscopic hysterectomy and sacrocolpopexy in women with stage ≥2 uterovaginal prolapse. Our primary outcome was patient-reported pain or dyspareunia at >2 years.
Of the 185 participants eligible for enrollment in the e-PACT study, 106 enrolled; 98 participants (96%) completed either in-person examinations or study questionnaires regarding pain and are included in this analysis. At >2 years, 28% reported any pain: 14% reported dyspareunia on questionnaires, 5% reported pelvic pain on questionnaires, and 14% of those who had an in-person examination reported pain. Of participants who reported pain or dyspareunia at baseline before surgery, 59% reported resolution of their symptoms >2 years. On multiple logistic regression controlling for age and baseline pain or dyspareunia, baseline pain or dyspareunia was associated with a nearly 3-fold increased risk of reporting any pain >2 years (adjusted odds ratio, 2.7; 95% confidence interval, 1.1-6.9). No women had repeat surgical intervention for pain.
Although 60% of women report pain resolution >2 years after surgery, de novo pain was present in 1 of 5 women. Baseline history of pain or dyspareunia is the only factor associated with an increased likelihood of experiencing pain >2 years after surgery.
关于子宫阴道脱垂手术治疗后患者报告的疼痛，长期数据有限。
本研究旨在评估接受微创全子宫切除术和使用轻质聚丙烯Y形网片（Upsylon）进行骶骨阴道固定术2年以上的女性的疼痛情况。
这是一项对一项5中心随机试验的计划二次分析，该试验比较了在≥2期子宫阴道脱垂女性的全腹腔镜子宫切除术和骶骨阴道固定术中，用于阴道固定轻质聚丙烯Y形网片的永久缝线与可吸收缝线。我们的主要结局是患者报告的2年以上的疼痛或性交困难。
在电子PACT研究中符合入组条件的185名参与者中，106名入组；98名参与者（96%）完成了关于疼痛的现场检查或研究问卷，并纳入本分析。在2年以上时，28%的人报告有任何疼痛：14%在问卷中报告有性交困难，5%在问卷中报告有盆腔疼痛，在接受现场检查的人中，14%报告有疼痛。在术前基线报告有疼痛或性交困难的参与者中，59%报告其症状在2年以上得到缓解。在控制年龄和基线疼痛或性交困难的多因素逻辑回归分析中，基线疼痛或性交困难与2年以上报告任何疼痛的风险增加近3倍相关（调整后的优势比为2.7；95%置信区间为1.1-6.9）。没有女性因疼痛而进行再次手术干预。
尽管60%的女性报告在手术后2年以上疼痛得到缓解，但仍有五分之一的女性出现新发疼痛。疼痛或性交困难的基线病史是与术后2年以上经历疼痛可能性增加相关的唯一因素。
