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Characterization of Pain After Inside-Out Transobturator Midurethral Sling

Cadish, Lauren A. MD*†; Hacker, Michele R. ScD*†‡; Modest, Anna Merport MPH*; Rogers, Kathleen J.§; Dessie, Sybil MD†§; Elkadry, Eman A. MD†§

Female Pelvic Medicine & Reconstructive Surgery: March/April 2014 - Volume 20 - Issue 2 - p 99–103
doi: 10.1097/SPV.0000000000000055
Original Articles

Objectives This study aimed to evaluate the prevalence, severity, duration, and location of pain after transobturator midurethral sling.

Methods We evaluated patients who underwent inside-out transobturator sling from March 2011 through February 2013. Presence of pelvic girdle pain, its severity, and location were documented preoperatively and at 2- and 6-week postoperative visits. Pain severity was measured on a scale of 1 to 10, with 10 being the “worst imaginable” pain.

Results Of the 130 women analyzed, the median age was 50.0 years (interquartile range, 44.0–62.0). Thirty-nine percent of women reported preoperative pain, mostly mild with a median score of 1.0 (1.0–5.0). The most common sites of postoperative-onset pain were the lateral leg, medial leg, groin, and low back. Women reporting preoperative pain were not more likely to report postoperative-onset pain than women without preoperative pain (P = 0.42). Twelve percent of women at 2 weeks and 0.8% at 6 weeks reported severe postoperative-onset pain. Women reporting postoperative-onset pain were equally likely to be satisfied with the procedure as those without pain at 2 (P = 0.76) and 6 (P = 0.74) weeks.

Conclusions Women undergoing transobturator sling commonly report preoperative pain. An expected postoperative increase in pain generally resolved by the sixth postoperative week. The lateral leg was the most common site of pain. Postoperative-onset pain was not associated with decreased patient satisfaction.

Pain after transobturator, inside-out midurethral sling is common, often resolved by the sixth postoperative week, and not associated with decreased patient satisfaction.

From the *Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center; †Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School; ‡Department of Epidemiology, Harvard School of Public Health, Boston; and §Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, MA.

Reprints: Lauren A. Cadish, MD, Department of Obstetrics and Gynecology, Division of Urogynecology, UC Irvine Medical Center, 101 The City Drive, Building 56, Suite 800, Orange, CA 92868. E-mail:; Eman A. Elkadry, MD, 725 Concord Ave, Suite 3300, Cambridge, MA 02138. E-mail:

The authors have declared they have no conflicts of interest.

This work was conducted with support from Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170-05 and financial contributions from Harvard University and its affiliated academic health care centers).

© 2014 by Lippincott Williams & Wilkins