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Pain after permanent versus delayed absorbable monofilament suture for vaginal graft attachment during minimally invasive total hysterectomy and sacrocolpopexy

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Abstract

Objectives

The objective was to evaluate pain and dyspareunia in women undergoing minimally invasive total hysterectomy and sacrocolpopexy (TLH + SCP) with a light-weight polypropylene mesh 1 year after surgery.

Methods

This is a planned secondary analysis of a randomized trial comparing permanent (Gore-Tex) versus absorbable suture (PDS) for vaginal attachment of a y-mesh (Upsylon™) during TLH + SCP in women with stage ≥II prolapse. Patient data were collected at baseline and 1 year after surgery. Our primary outcome was patient-reported pain or dyspareunia at 1 year.

Results

Two hundred subjects (Gore-Tex n = 99, PDS n = 101) were randomized and underwent surgery. Overall, the mean age ± SD was 60 ± 10 years, and BMI was 27 ± 5 kg/m2. The majority were white (89%), menopausal (77%), and had stage III/IV (63%) prolapse. 93% completed a 1-year follow-up and are included in this analysis (Gor-Tex n = 95, PDS n = 90). The overall rate of participants who reported pain at 1 year was 20%. Of those who did not report any pain at baseline, 23% reported de novo dyspareunia, 4% reported de novo pain, and 3% reported both at 1 year. Of participants who reported pain or dyspareunia at baseline prior to surgery, 66% reported resolution of their symptoms at 1 year. There were no differences in most characteristics, including mesh/suture exposure (7% vs 5%, p = 0.56) between patients who did and did not report any pain at 1 year. On multiple logistic regression controlling for age, baseline dyspareunia, and baseline pain, baseline dyspareunia was associated with a nearly 4-fold increased odds of reporting any pain at 1 year (OR 3.8, 95%CI 1.7–8.9).

Conclusions

The majority of women report resolution of pain 1 year following TLH + SCP with a low rate of de novo pain.

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Authors and Affiliations

  1. Northwestern Feinstein School of Medicine, 250 E. Superior St. Suite 5-2370, Chicago, IL, 60611, USA

    C. Emi Bretschneider & Kimberly Kenton

  2. Departments of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA

    Elizabeth J. Geller & Jennifer M. Wu

  3. Department of Urology, Wake Forest Baptist Health, Winston Salem, NC, USA

    Catherine A. Matthews

Authors
  1. C. Emi Bretschneider
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  2. Kimberly Kenton
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  3. Elizabeth J. Geller
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  4. Jennifer M. Wu
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  5. Catherine A. Matthews
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Contributions

C.E. Bretschneider: project development, manuscript writing; K. Kenton: project development, data collection, manuscript writing; E.J. Geller: data collection, manuscript writing; J.M. Wu: data collection, manuscript writing; C.A. Matthews: project development, data collection, manuscript writing.

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Correspondence to C. Emi Bretschneider.

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Conflicts of interest

Catherine A. Matthews and Kimberly Kenton are consultants for Boston Scientific Corporation and expert witnesses for defense, Johnson & Johnson. The other authors did not report any potential conflicts of interest. “Permanent versus delayed absorbable monofilament suture for vaginal graft attachment during minimally invasive total hysterectomy and sacrocolpopexy: a randomized control trial” (PACT trial) was sponsored by Boston Scientific Corporation.

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Bretschneider, C.E., Kenton, K., Geller, E.J. et al. Pain after permanent versus delayed absorbable monofilament suture for vaginal graft attachment during minimally invasive total hysterectomy and sacrocolpopexy. Int Urogynecol J 31, 2035–2041 (2020). https://doi.org/10.1007/s00192-020-04471-6

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  • DOI: https://doi.org/10.1007/s00192-020-04471-6

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