Is pain relief after vaginal mesh and/or sling removal durable long term?

INTRODUCTION AND HYPOTHESIS: This study was to review our experience of pain relief durability in women who experienced initial pain resolution after vaginal mesh and/or sling removal (VMSR).

METHODS: A retrospective chart review of consecutive, nonneurogenic women who underwent VMSR for pain and reported persistent pain relief at the 6-month postoperative follow-up visit were assessed. Pre- and postoperative data collected were self-reported chief complaints, physical examination, other medical conditions associated with chronic pain, use of pain medications, Urogenital Distress Inventory-6 (in which question 6 specifically addresses pain), and the Numerical Pain Rating Scale (NPRS). Success was defined by continued resolution of pain assessed by score of 0 on NPRS (0 none to 10 terrible), (0-1 on the Urogenital Distress Inventory-6 (UDI-6) question 6, subjective report of pain-free status, and/or no chronic use of pain medications other than those prescribed for non-mesh-related pain.

RESULTS: Between 2006 and 2015, 125 of 356 women met study criteria. Mean follow-up after VMSR was 3.5 (range 0.5-10) years. Among 25 women who did not meet success criteria by questionnaire answers or subjective report, 21 had causes unrelated to their original mesh/sling placement and were pain free after they were addressed. Four women experienced delayed mesh-related pain return at 28, 46, 47, and 54 months, respectively; two required mesh removal surgery. Involvement in lawsuits and chronic pain-related medical conditions did not affect the durability of pain relief.

CONCLUSIONS: At a mean follow-up of 3.5 years, the original pain relief noted after VMSR was durably maintained.