Outcomes Following Multidisciplinary Management of Women With Residual Pelvic Pain and Dyspareunia Following Synthetic Vaginal Mesh and/or Mesh Sling Removal

Abstract

Background: Transvaginal synthetic mesh and mesh sling placement for the treatment of stress urinary incontinence and pelvic organ prolapse can yield adverse outcomes, including pelvic pain and dyspareunia, that persist after implant removal. Objective: To describe the clinical presentations of women with residual pelvic pain or dyspareunia after synthetic vaginal mesh and/or mesh sling removal and the effectiveness of treatments using a multidisciplinary approach. Study Design: After receiving institutional review board approval, a neutral reviewer retrospectively analyzed a prospectively maintained database of women who experienced pelvic pain/dyspareunia after implant removal and were referred to a physiatrist specializing in pelvic rehabilitation medicine. Methods: Included were women who were evaluated by a physiatrist following implant removal. Excluded were women seen for symptoms other than pain or pending subsequent resection procedures. Primary outcome was pelvic pain score assessed by a Numeric Pain Rating Scale obtained at each physiatrist and physical therapy visit. Success was defined as a 50% or greater reduction in pain score. All patients underwent pelvic floor physical therapy, with medications and injections as necessary. Results: From 2010 to 2015, 37 women were included in the analysis. Of these, 4 had isolated dyspareunia and the remaining 33 had general pelvic pain. Eight of these 33 (24%) achieved a successful outcome. When evaluating compliance, half (14 of 28) of the compliant patients achieved improvement in pain scores. Compliant patients treated for isolated dyspareunia experienced more than 80% improvement. Conclusion: Pelvic pain-focused interventions are a worthwhile recommendation in women with refractory pelvic pain after vaginal mesh or mesh sling removal.