Main findings
In this randomized controlled trial, we were able to demonstrate that vaginal packing after LSC is not associated with increased pain. This finding is in agreement with studies assessing pain after vaginal reconstructive surgeries. Using similar methodology Thiagamoorthy et al. have shown comparable pain scores in groups with and without packing after vaginal hysterectomy with or without associated prolapse surgery. Summed score of the McGill Pain questionnaire was used for comparison. In this study the individual scores of the short form McGill Pain Questionnaire were evaluated separately as was recommended by the author of the questionnaire 12. Interestingly, upon comparison with a study of vaginal packing after vaginal hysterectomy using the same measure 5, it seems that LSC is less painful in follow-up. A recent study on vaginal packing following vaginal pelvic reconstructive surgery has shown even lower VAS pain scores 13.
High patient satisfaction with the surgery and overall postoperative course, which was not affected by vaginal packing was observed in this study. This result is in line with a previous study comparing patient satisfaction after vaginal reconstruction surgery, although the satisfaction levels were higher in that study 4. LSC is more demanding surgery, with a higher anaesthesiologic risk and possibly higher early postoperative morbidity. In the study period the patients spent the day of the surgery on the postoperative intermediate care unit for closer monitoring. This could have affected the patient satisfaction.
Vaginal packing did not have any effect on urinary tract infections. No symptomatic urinary tract infection was treated in the study period. Asymptomatic bacteriuria on postoperative day 4 was found in 13% of patients. No difference between the groups was found. In spite of the fact that the patients did not have a midstream urine culture test performed before the surgery, given the cultured strains, the bacterial colonization was probably pre-existing. The rate of asymptomatic bacteriuria in or sample is not surprising as 6 – 16% prevalence of asymptomatic bacteriuria among women aged 65 to 90 years was reported14. Foley catheter was inserted until the morning after the surgery regardless of study group assignment.