A Clinically Applied Anatomical Study Of Pain Induced By Pelvic Floor Reconstruction Surgery

BackgroundPelvic organ prolapse(POP)is the most significant pelvic floor dysfunction,which has a tremendous effect on a patient's quality of life.For patients with severe and recurrent prolapse,surgical treatment is currently the only effective treatment.The use of synthetic mesh in pelvic reconstructive surgery has proven to be both anatomically and subjectively beneficial,and has become the standard surgical option for pelvic organ prolapse.Unfortunately,mesh-related complications have made the surgery controversial,particularly pain caused by mesh.To the best of our knowledge,there are currently few studies on the mechanisms and anatomical basis of transvaginal mesh related postoperative pain.Methods10 fresh female cadavers were collected and modified pelvic reconstructive surgery with transvaginal mesh was performed in 9 out of the 10 cadavers.Surgery was followed by detailed dissection of the pudendal nerve and its branches.Course of pudendal nerve and its branches were observed and recorded in all 10 cadavers,along with measurements of important anatomical structures such as the lengths of sacrospinous ligament and sacrotuberous ligament.Relevant distances between the mesh and surrounding structures,especially pudendal nerve and its branches,were recorded in the nine cadavers that had underwent transvaginal mesh placement.ResultsThe course of the pudendal nerve and its branches was similar to previous reports.The average length of the sacrospinous ligament measured in our study was 41.7±4.4mm on the left and 41.6±4.7mm on the right.In 35%(7/20)of the cadavers,the sacrospinous ligament was less than 4cm.Among pudendal nerve and its three main branches,pudendal nerve had the closest distance between the mesh and itself,with an average distance of 5.4±3.6mm on the left and 4.5±3.9mm on the right.In 27.8%(5/18)of the cadavers,the pudendal nerve is in close contact with the mesh.ConclusionAccording to the detailed dissection in fresh cadavers,the course of the pudendal nerve was confirmed consistent with previous reports.The length of the sacrospinous ligament of Chinese women may have a potential diversity.Therefore,sutures should be as superficial and solid as possible when performed on the sacrospinous ligament,which might be more effective for preventing injuries of surrounding structures than the selection of suturing site.Pudendal nerve is closely related to the path of the implanted mesh,and might be interfered by mesh contraction to cause postoperative pain,while its branches are probably not related.