title: Pudendal neuralgia following transobturator inside-out tape procedure (TVT-O)--case report and anatomical study.
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.
authors: Department of Obstetrics and Gynaecology, First Medical Faculty, Charles University and General Teaching Hospital in Prague, Prague, Czech Republic. masata@volny.cz
authors: Jaromir
authors: J
authors: Masata
authors: Petr
authors: P
authors: Hubka
authors: Alois
authors: A
authors: Martan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000777:Anesthetics / Q000627:therapeutic use; D002102:Cadaver; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011184:Postoperative Period; D060525:Pudendal Nerve / Q000293:injuries; D060545:Pudendal Neuralgia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D053825:Suburethral Slings; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
chemical_list: D000305:Adrenal Cortex Hormones; D000777:Anesthetics