[Management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage].
BACKGROUND
All surgical procedures require an incision with a risk of nerve damage at the site of the scar or as a result of fibrotic scar tissue. The purpose of this article is to describe the management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage.


METHODS
A comprehensive review of the literature was performed by searching PUBMED for articles on the management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage.


RESULTS
Postoperative lesions of parietal somatic nerves (ilioinguinal, iliohypogastric, genitofemoral, pudendal, obturator, femoral) are frequent after pelvic surgery. Clinical examination of the scars (trigger zone) and detailed analysis of the topography and type of pain are essential elements in the analysis of this pain. Infiltration of local anaesthetic at the trigger point or along the nerve has a diagnostic value. Corticosteroid infiltrations and minimally invasive treatments such as pulsed radiofrequency have provided more or less lasting improvement of the symptoms. Surgical nerve release together with resection of fibrosis and removal of prosthetic material provides good long-term results. The surgical approach depends on the nerve concerned and the level of the lesion.


CONCLUSIONS
The management of chronic postoperative pelvic and perineal pain due to parietal somatic nerve damage is based on local infiltration of anaesthetics and corticosteroids. Nerve release surgery with resection of fibrosis provides the best long-term results.
Clinique urologique, centre fédératif de pelvipérinéologie, hôpital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France. jrigaud@chu-nantes.fr
J
J
Rigaud
D
D
Delavierre
L
L
Sibert
J-J
JJ
Labat
D002908:Chronic Disease; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology* / Q000628:therapy*; D017699:Pelvic Pain / Q000209:etiology* / Q000628:therapy*; D010388:Pelvis / Q000294:innervation; D010502:Perineum / Q000294:innervation; D020196:Trauma, Nervous System / Q000150:complications*