Pain and sexual function after E-PACTII: Permanent vs Delayed-Absorbable Suture for TLH & SCP

Objectives: Data regarding long-term pain outcomes after prolapse surgery are limited. As sacrocolpopexy is increasingly utilized for primary treatment of pelvic organ prolapse, understanding the relationship between abdominal mesh-augmented prolapse repairs and patient-reported pain outcomes has become increasingly important. To evaluate pain and sexual function in women undergoing minimally-invasive total hysterectomy and sacrocolpopexy (TLH+SCP) with a light-weight polypropylene mesh (Upsylon™) > 3 years after surgery.

Methods: This is a planned extended secondary-analysis of a 5-site randomized trial comparing permanent (2-0 GoreTex) vs absorbable suture (2-0 PDS) for vaginal attachment of a lightweight polypropylene y-mesh during TLH+SCP in women with stage≥II prolapse. Sociodemographic, exam and pain data were collected at baseline, > 3 years after surgery. Our primary outcome was patient-reported pain or dyspareunia at > 3 years. Our secondary outcome was sexual function at > 3 years.

Results: Of the 185 subjects eligible for enrollment in the e-PACT study, 106 subjects enrolled. Of these, 82 subjects completed either in person examinations and/or questionnaires >36 months postoperatively and are included in this analysis. Table 1 describes the demographics of the study population. The mean follow-up time was 64 months (range 36 to 90). The mean age±SD was 59±9 years and BMI was 28±5 kg/m². The majority of women were White (92%), never smokers (88%), and at the time of follow-up, 30% reported using vaginal estrogen. The majority of women (92.7%) reported “Very much better”, “Much better” or “A little better” on the PGII questionnaire. Table 2 describes pain and sexual function outcomes. In terms of baseline characteristics, 23 women (45%) reported pain, 22 (43%) reported dyspareunia, and 4 (7.8%) reported pain prior to surgery. At > 3 years, few women reported pain on exam (2/56, 3.6%), pelvic pain (2/79, 2.5%) or pain reported by partner (0/79, 0%); however, 8 women (10%) reported dyspareunia. Of those who reported dyspareunia at >3 years, none had dyspareunia at baseline; conversely, of those who reported dyspareunia at baseline, dyspareunia had resolved for all at > 3 years following surgery. No differences were noted across suture type in terms of pain or sexual function outcomes >3 years following surgery. In terms of sexual function, while no differences existed between groups, the overall mean PISQIR score was below the 2.68 summary score cutoff, suggesting lower sexual function; however, among sexually active women, the mean score was 3.2 (0.3), reflecting no sexual dysfunction.

Conclusions: Of women who followed up >3 years following TLH+SCP, women with dyspareunia at baseline reported resolution of pain; while 1 in 10 women report de novo dyspareunia. Among sexually active women, PISQIR scores reflect no sexual dysfunction.