Abstract
Persistent pain after TVT-O procedure is a rare complication. Nerve injuries have been suspected as a cause of persistent pain. We present one case of atypical postoperative pain—pudendal neuralgia following TVT-O procedure—which persisted 3 years after the primary procedure. The patient required surgical removal of the tape, which brought only partial relief. Complete relief from pain was afterwards achieved with repeated local applications of anesthetics with corticosteroids. The recurrent stress urinary incontinence was treated with retropubic TVT. Pudendal nerve irritation was also described after retropubic sling procedure, and the cadaveric dissection indicated the theoretic possibility of nerve injury during retropubic sling procedure. To explain the mechanism of nerve injury, we performed cadaveric dissections on a formalin-embalmed female body. We were able to demonstrate the contact of the needle with the pudendal nerve after aberrant passage of the inserter.
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Acknowledgment
This work was supported by the Grant Agency of the Ministry of Health of the Czech Republic, grant NS 10586-3/2009 and Grant Agency of Charles University in Prague, and grant GAUK 3596/11.
Conflicts of interest
Jaromir Masata and Petr Hubka have no conflicts of interest. Alois Martan is a perceptor of Gynecare.
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Masata, J., Hubka, P. & Martan, A. Pudendal neuralgia following transobturator inside-out tape procedure (TVT-O)—case report and anatomical study. Int Urogynecol J 23, 505–507 (2012). https://doi.org/10.1007/s00192-011-1555-4
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DOI: https://doi.org/10.1007/s00192-011-1555-4