title: Functional results after tape removal for chronic pelvic pain following tension-free vaginal tape or transobturator tape.
abstract: OBJECTIVE
  The incidence of pelvic pain after placement of a suburethral sling for incontinence ranges between 0% and 30%. The management of this chronic pain after suburethral sling placement is complex and to our knowledge no consensus has been reached. We evaluated the functional results after removal of the suburethral tape responsible for chronic pelvic pain.
  
  
  METHODS
  From November 2004 to August 2009, 32 patients undergoing removal of suburethral tape causing chronic pelvic and perineal pain at our department were prospectively followed. Patients were divided according to the type of suburethral sling into the transobturator tape group (15 patients) and the tension-free vaginal (retropubic) tape group (17 patients). In the TVT group tape removal was performed using transperitoneal laparoscopy in every patient. In the TOT group tape removal was performed via a transvaginal approach possibly associated with a unilateral or bilateral incision in the proximal part of the thigh. Pain was evaluated by a visual analogue scale from 0-no pain to 10-maximal pain.
  
  
  RESULTS
  The surgical exploration of suburethral tape responsible for chronic, treatment refractory pelvic pain revealed in most cases an abnormal tape position or excessive tape traction. In the overall population tape removal provided improvement of pain (at least 50% improvement of the visual analogue scale score) in 68% with a mean followup of 10 months. Mean visual analogue scale score was 7.3 +/- 1.5 before surgery and 3.4 +/- 3 after surgery. However, recurrence of incontinence was observed in 22% of cases. No significant difference was demonstrated in terms of functional results according to the type of tape insertion.
  
  
  CONCLUSIONS
  The surgical removal of suburethral tape improved pain in 68% of patients but with a risk of recurrence of urinary incontinence in 22%.
authors.affiliation: Urology Clinic, Hôtel-Dieu, Nantes University Hospital Centre, Nantes, France. jrigaud@chu-nantes.fr
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rigaud
authors.forename: Patrice
authors.initials: P
authors.lastname: Pothin
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Labat
authors.forename: Thibault
authors.initials: T
authors.lastname: Riant
authors.forename: Michel
authors.initials: M
authors.lastname: Guerineau
authors.forename: Loïc
authors.initials: L
authors.lastname: Le Normand
authors.forename: Pascal
authors.initials: P
authors.lastname: Glemain
authors.forename: Roger
authors.initials: R
authors.lastname: Robert
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchot
mesh_terms: D002908:Chronic Disease; D020878:Device Removal; D005260:Female; D006801:Humans; D008875:Middle Aged; D017699:Pelvic Pain / Q000209:etiology* / Q000628:therapy*; D011446:Prospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome