Pain after suburethral sling insertion for urinary stress incontinence
- 732 Downloads
Introduction and hypothesis
Pain after suburethral sling insertion is an uncommon, but troublesome complication of continence surgery; in some cases it can cause significant distress and disability. It is often not recognised, poorly diagnosed and treated by gynaecologists and urologists unfamiliar with the condition.
A literature review was performed and the current evidence on pain after suburethral sling insertion reviewed.
The tension-free vaginal tape–obturator (TVT-O) procedure is associated with an increased incidence of early groin pain, but this often resolves with expectant management. Chronic pain may be difficult to treat. The injection of local anaesthetic and steroid solutions may provide relief in some patients. Cognitive behavioural therapy has a place in treatment. In resistant cases, surgical excision may be needed. Retropubic slings can be removed laparoscopically or by open exploration of the Cave of Retzius. Obturator tapes may require groin exploration.
Sling removal may result in recurrent incontinence and further tissue and nerve damage. It does not always cure pain and may exacerbate the problem.
KeywordsPain Sling TVT TVT-O CBT Review
Conflicts of interest
- 4.FDA, Urogynecologic Surgical Mesh: July 2011. Update on the Safety and Effectiveness of Transvaginal Placement for Pelvic Organ ProlapseGoogle Scholar
- 6.Mendenhall A, Addis IB (2008) Preincision Lidocaine versus placebo for prevention of postoperative groin pain in women undergoing midurethral sling placement via the obturator space. J Pelvic Surg 14/4(270):1542–5982Google Scholar
- 26.Madhuvrata P, Riad M, Ammembal MK, Agur W, Abdel-Fattah M (2010) A systematic review and meta-analysis of the efficacy and complications of the inside-out versus the outside-in transobturator tapes in the management of female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 21 [Suppl 1] (abstract 3) S4Google Scholar
- 45.Hubka P, Nanka O, Martan A, Svabik K, Zvarova J, Masata J (2011) Anatomical study of position of the TVT-O to the obturator nerve influenced by the position of the legs during the procedure: based upon findings at formalin-embalmed and fresh-frozen bodies. Arch Gynecol Obstet 284:901–905PubMedCrossRefGoogle Scholar
- 50.Kim S, Choi JY, Huh YM et al (2007) Role of magnetic resonance imaging in entrapment and compressive neuropathy - what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image. Part I. Overview and lower extremity. Eur Radiol 17:139–149PubMedCrossRefGoogle Scholar
- 62.Eccleston C, Williams AC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2009; 15:CD007407Google Scholar
- 64.Roupret M, Misrai V, Vaessen C, Cour F, Haertig A, Chartier-Kastler E (2010) Laparoscopic surgical complete sling resection for tension-free vaginal tape-related complications refractory to fist-line conservative management: a single-centre experience. Eur Urol 58:270–274PubMedCrossRefGoogle Scholar