For women with pain after urogynecological mesh insertion, symptoms are often not improved by mesh removal, according to a study published online May 29 in BJOG: An International Journal of Obstetrics and Gynaecology.
Natalie Pace, M.D., from the University of Pittsburgh School of Medicine, and colleagues conducted a prospective, longitudinal cohort study involving women undergoing complete vaginal mesh excision for mesh exposure and/or pain. Data were included for 173 women: 48, 27, and 98 underwent removal for pain, exposure, and exposure plus pain, respectively.
The researchers found that 75 percent of patients reported moderate-to-severe baseline symptoms; dyspareunia was the most prevalent and severe symptom. Women with pain alone were the most bothered, and they reported the highest functional impact. After excision, improved symptoms were reported for 33.3 percent of women with pain alone compared with 73.9 percent of those with exposure and 58.3 percent of those with exposure plus pain; no differences were seen in Patient Global Impression of Improvement by mesh type. In all groups, the visual analog scale scores decreased, while pain patients had no improvement in the Pelvic Floor Distress Inventory or Pelvic Functional Impact Questionnaire.
“Our findings suggest that surgical management of exposure has better outcomes in the absence of pain,” the authors write. “Patients with pain may continue to have symptoms and reduced quality of life.”