title: Pain after suburethral sling insertion for urinary stress incontinence.
abstract: OBJECTIVE
  Pain after suburethral sling insertion is an uncommon, but troublesome complication of continence surgery; in some cases it can cause significant distress and disability. It is often not recognised, poorly diagnosed and treated by gynaecologists and urologists unfamiliar with the condition.
  
  
  METHODS
  A literature review was performed and the current evidence on pain after suburethral sling insertion reviewed.
  
  
  RESULTS
  The tension-free vaginal tape-obturator (TVT-O) procedure is associated with an increased incidence of early groin pain, but this often resolves with expectant management. Chronic pain may be difficult to treat. The injection of local anaesthetic and steroid solutions may provide relief in some patients. Cognitive behavioural therapy has a place in treatment. In resistant cases, surgical excision may be needed. Retropubic slings can be removed laparoscopically or by open exploration of the Cave of Retzius. Obturator tapes may require groin exploration.
  
  
  CONCLUSIONS
  Sling removal may result in recurrent incontinence and further tissue and nerve damage. It does not always cure pain and may exacerbate the problem.
authors: Department of Obstetrics and Gynaecology, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent ME7 5NY, UK. jraduckett@hotmail.com
authors: Jonathan
authors: J
authors: Duckett
authors: Andrew
authors: A
authors: Baranowski
mesh_terms: D000779:Anesthetics, Local; D015928:Cognitive Behavioral Therapy; D020878:Device Removal; D005260:Female; D006801:Humans; D017699:Pelvic Pain / Q000209:etiology* / Q000628:therapy*; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local