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.