A randomized comparison of post-operative pain, quality of life, and physical performance during the first 6 weeks after abdominal or vaginal surgical correction of descensus uteri.
OBJECTIVE
With respect to urogenital function, vaginal hysterectomy combined with anterior and/or posterior colporraphy has been shown to be superior to abdominal sacrocolpopexy with preservation of the uterus. We performed a randomized trial to compare the effects of both procedures on pain, quality of life and physical performance during the first six weeks after surgery.


METHODS
Eighty-two patients were randomized to have surgery either by vaginal or abdominal approach. All patients were asked to complete the RAND-36 before surgery and 6 weeks after surgery and to keep a diary for the first 6 weeks after surgery. This diary assessed the pain perception and use of pain medication, bother of limitations due to the surgery and performance of daily activities after surgery. These outcomes were compared.


RESULTS
All patients completed the RAND-36 and 68 patients completed the diary. Patients who had undergone abdominal surgery had a statistically lower score on the health change domain (56 vs 68), bodily pain domain (63 vs 80) and mental health domain (74 vs 81) of the RAND-36, as compared to patients who had undergone vaginal prolapse surgery. During hospital stay, the abdominal group experienced on average more days of pain (4.5 vs 3.0) and impaired mobility (3.7 vs 2.9) as compared to the vaginal group. Patients received more pain medication following abdominal surgery as compared to vaginal surgery.


CONCLUSIONS
The vaginal operation to correct a descensus uteri is associated with less pain, better quality of life and better mobility during the first 6 weeks of the recovery period as compared to the abdominal approach.
Roovers
J P W R
JP
Department of Obstetrics and Gynecology, University Medical Center Utrecht, The Netherlands. j_proovers@hotmail.com
van der Bom
J G
JG
van der Vaart
C H
CH
van Leeuwen
J H Schagen
JH
Scholten
P C
PC
Heintz
A P M
AP
D000005:Abdomen / Q000601:surgery*; D000203:Activities of Daily Living; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology* / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014563:Urodynamics; D013520:Urologic Surgical Procedures; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*