1549 POSTOPERATIVE PAIN OUTCOMES AFTER URETHROLYSIS

Abstract

INTRODUCTION AND OBJECTIVES: Preoperative pain complaints are common in patients presenting for urethrolysis. Herein we determined the pain characteristics and outcomes for patients undergoing urethrolysis. METHODS: Retrospective review was conducted of electronic medical records of female patients who underwent urethrolysis from January 2000 to August 2010. Patients were excluded if a concomitant procedure was performed at the time of urethrolysis. We assessed patient demographics, presenting symptoms, preoperative and postoperative pain characteristics, pain outcome and the need for any subsequent pain management. RESULTS: 45 patients met inclusion criteria. Median age was 51.8 years and median follow-up was 9.4 (IQR 17.9) months. Median time to urethrolysis from symptom onset was 8 (IQR 19) months. Most frequently identified source procedures were midurethral slings (19 patients, 42%) and pubovaginal slings (15 patients, 33%). 8 patients [18%] had undergone previous attempts at urethrolysis. Pain and urgency were the most common presenting symptoms (20 patients, 44%). For 7 patients [16%], pain was the most bothersome symptom. Eighty-five percent of patients with pain (17/20) reported de novo pain after their source procedure. Urethrolysis was performed transvaginally in 60% (12/20), retropubically in 25% (5/20) and 15% (3/20) had suburethral sling lysis. 14/20 [70%] had complete resolution of their pain symptoms immediately after urethrolysis. 3/20 [15%] patients reported ongoing but “improved” pain. The remaining 3 patients [15%] had postoperative pain which recurred within one week, one month and six months respectively. These patients had undergone transvaginal urethrolysis [3, 50%], retropubic urethrolysis [2, 33%] and suburethral sling lysis [1, 17%]. Severity of pain was described as “mild” in 4 patients and “moderate” in 2 patients. Patients with “moderate” pain required oral analgesics and one required a formal pain consultation. At last follow-up, 5/6 [83%] of these patients had no pain. CONCLUSIONS: Pain is a frequently reported and bothersome symptom in patients requiring urethrolysis. After uncomplicated urethrolysis procedures, regardless of technique used, approximately 95% of patients experienced complete resolution of pain symptoms by six months postoperatively. These are powerful and encouraging results for counseling patients who have already had unfavourable outcomes from a previous procedure.