Groin pain after a tension-free vaginal tape or similar suburethral sling: management strategies.
OBJECTIVE
To review different treatment strategies for women with groin pain after tension-free vaginal tape (TVT) or similar suburethral sling procedures.


METHODS
The series comprised 450 women who had a TVT procedure, with a follow-up of 3-50 months. Five women (1%) reported significant groin pain and were offered further treatment. In addition, one woman was referred from another centre and received treatment.


RESULTS
Women with pain were initially treated conservatively, and in most the pain resolved and required no further treatment. Persistent or severe discomfort was treated with a combined steroid (methyl prednisolone, 2 mL, 80 mg) and local anaesthetic (bupivacaine, 10 mL, 0.5%) injection in four women. There were no side-effects from the treatment. One woman was relieved of her pain and required no further treatment. In one woman the local injections failed to improve her symptoms but the pain was not severe enough to warrant further treatment. Two women developed recurrent pain after an initially successful injection, and in these women the TVT was excised. One woman referred from another centre was primarily treated with TVT excision. In the three women treated with distal tape excision, the mean pain scores decreased from 8.7 before excision to 0.7 afterward. One woman is awaiting tape excision.


CONCLUSIONS
If conservative management fails to relieve the symptoms of groin pain it can be treated by injecting a mixture of steroid and local anaesthetic. However, local injection failed to provide long-term relief in three of four women. More severe symptoms might require TVT mesh dissection and excision, which provided significant pain relief.
Duckett
Jonathan R A
JR
Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent ME7 5NY, UK. jraduckett@hotmail.com
Jain
Smita
S
D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006119:Groin; D006801:Humans; D007267:Injections; D008775:Methylprednisolone / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D019736:Prostheses and Implants; D013526:Surgical Mesh; D014521:Urethra / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
D000779:Anesthetics, Local; D005938:Glucocorticoids; D008775:Methylprednisolone; D002045:Bupivacaine