Pudendal neuralgia following transobturator inside-out tape procedure (TVT-O)--case report and anatomical study
Language English Country England, Great Britain Media print-electronic
Document type Case Reports, Journal Article, Research Support, Non-U.S. Gov't
- MeSH
- Anesthetics therapeutic use MeSH
- Gynecologic Surgical Procedures adverse effects methods MeSH
- Adrenal Cortex Hormones therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Cadaver MeSH
- Postoperative Period MeSH
- Pudendal Nerve injuries MeSH
- Pudendal Neuralgia diagnosis drug therapy etiology MeSH
- Urinary Incontinence, Stress surgery MeSH
- Suburethral Slings * MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Anesthetics MeSH
- Adrenal Cortex Hormones MeSH
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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