Comparison of the Effect of Different Dosages of Celecoxib on Reducing Pain after Cystocele and Rectocele Repair Surgery

Background: Administration of celecoxib reduces pain and inflammation and is associated with greater patient satisfaction. Objective: This study was designed to evaluate the efficacy of two different doses of oral celecoxib for reducing postoperative pain. Methods: This randomized clinical trial was performed on 90 patients undergoing cystocele and rectocele repair under spinal anesthesia. Patients were randomly divided into 3 groups: the first group received 200 mg/day celecoxib, the second group received 400 mg/day celecoxib and the third group was placebo. The pain was measured at 8, 16 and 24 hours after surgery using the VAS (Visual Analogue Scale) method. If the pain score was greater than 5, pethidine 1 mg/kg was prescribed. Pain score at 8, 16 and 24 hours, the need for pethidine, side effects and satisfaction score were recorded during the first 24 hours after surgery. Results: The pain score at postoperative 8 hours was 7.7, 3.9, and 8.1 in the 200 mg/day celecoxib, 400 mg/day celecoxib, and placebo group, respectively (p<0.001). Furthermore, the need for pethidine was significantly less in 400 mg/day group and with the greatest satisfaction score, p<0.01, respectively. Conclusion: Our study concludes that 400 mg/day of celecoxib can be effective against postoperative pain, following the cystocele and rectocele repair, as compared to 200 mg/day and placebo groups. Unwanted use of opioids can be avoided with economically cheaper and safer drugs.

Robotic sacrocolpopexy for the management of pelvic organ prolapse: quality of life outcomes

Background: Our aim was to investigate longer-term surgical and quality of life (QOL) outcomes in a cohort of women undergoing robotic-assisted laparoscopic sacrocolpopexy (RALS) for pelvic organ prolapse (POP). Methods: We performed a retrospective cohort study at a single institution of female patients undergoing RALS with and without concomitant robotic-assisted laparoscopic hysterectomy, urethral sling, and rectocele repair. Scores from the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) surveys were used to evaluate QOL outcomes. Clinical improvement was defined by a decrease in a patient’s PFDI and PFIQ postoperative score by ⩾70%. Results: Clinical improvement was seen in 62.6% by the PFIQ and in 64% by the PFDI survey. Younger patient age (OR 0.92, p = 0.011) and worse preoperative American Urological Association (AUA) Quality of Life score (OR 1.42, p = 0.046) were associated with clinical improvement. Within the PFIQ, 35.6% of patients saw clinical improvement with their bowel symptoms, compared with bladder (54.1%, p < 0.001) and prolapse (45.6%, p = 0.053) symptoms. Within the PFDI, 45.5% of patients reached clinical improvement with their bowel symptoms, compared with bladder (56.7%, p = 0.035) and prolapse (62.6%, p < 0.001) symptoms. Of the patients who had a rectocele repair, 46.3% reached clinical improvement in their CRADI-8 score, and 51% saw clinical improvement in the bowel portion of the PDFI. Conclusions: Significantly fewer patients reached clinical improvement within the portions of the surveys that focus on bowel symptoms, compared with symptoms related to urination and POP. Of those that had a concomitant rectocele repair, approximately half reached clinical improvement with their bowel symptoms.