Pain Scores and Exposure Rates after Polypropylene Mesh for Pelvic Organ Prolapse.

OBJECTIVES: To characterize pain and exposure after Prolift placement and identify risk factors. METHODS: A case series of women who underwent Prolift vaginal mesh were surveyed. Pain was assessed using a visual analog scale. Exposure was evaluated clinically. RESULTS: Of 183 eligible patients, 160 completed the survey, and 45 returned for examination. Mean preoperative pain score was 0.97 and postoperative was 1.35 (P = 0.12). Pre- and postoperative pain scores by compartment were: anterior (1.34 vs 1.25, mean change -0.09, P = 0.84), posterior (1.30 vs 1.56, mean change 0.26, P = 0.72), and total (0.63 vs 1.34, mean change 0.71, P = 0.05). Graft exposure was confirmed in 23 of 183 patients (12.6%); however, because asymptomatic patients were not examined, the true exposure rate may be underestimated. Hematoma formation is independently associated with mesh exposure, adjusted odds ratio 18.4 (95% confidence interval 3.4-147.4, P = 0.01). CONCLUSIONS: Although pain scores did not increase overall, there was a trend toward increased pain score in the patients with total (anterior and posterior) Prolift. Hematoma formation was significantly associated with mesh exposure.

Obliterative vaginal surgery for pelvic organ prolapse.

Obliterative vaginal surgery is an appropriate management option for pelvic organ prolapse in women who do not desire future vaginal intercourse. When colpoclesis is not technically feasible, constricting repairs can be performed. Obliterative surgery in older women has the advantages of fewer complications and less surgical time than reconstructive procedures, especially in those with medical comorbidities. Age-related changes in physiology should be kept in mind along with the risk of postoperative delirium. Candidates should be counseled regarding high success and satisfaction rates.