title: Dorsal clitoral nerve injury following transobturator midurethral sling.
abstract: BACKGROUND
  Transobturator slings can be successfully used to treat stress urinary incontinence and improve quality of life through a minimally invasive vaginal approach. Persistent postoperative pain can occur and pose diagnostic and therapeutic dilemmas. Following a sling procedure, a patient complained of pinching clitoral and perineal pain. Her symptoms of localized clitoral pinching and pain became generalized over the ensuing years, eventually encompassing the entire left vulvovaginal region.
  
  
  OBJECTIVE
  The aim of this study was to highlight the clinical utility of conventional pain management techniques used for the evaluation and management of patients with postoperative pain following pelvic surgery.
  
  
  METHODS
  We described a prototypical patient with persistent pain in and around the clitoral region complicating the clinical course of an otherwise successful sling procedure. We specifically discussed the utility of bedside sensory assessment techniques and selective nerve blocks in the evaluation and management of this prototypical patient.
  
  
  RESULTS
  Neurosensory assessments and a selective nerve block enabled us to trace the source of the patient's pain to nerve entrapment along the dorsal nerve of the clitoris. We then utilized a nerve stimulator-guided hydrodissection technique to release the scar contracture.
  
  
  CONCLUSIONS
  This case demonstrates that the dorsal nerve of the clitoris is vulnerable to injury directly and/or indirectly. Assimilation of a time-honored pain management construct for the evaluation and management of patients' pain may improve outcomes while obviating the need for invasive surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Ohio State University School of Medicine, Columbus, OH, USA.
authors.forename: Chailee F
authors.initials: CF
authors.lastname: Moss
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Damitz
authors.affiliation: Department of Endodontics, University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Gracely
authors.affiliation: Department of Endodontics, University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Alice C
authors.initials: AC
authors.lastname: Mintz
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, NC, USA; Department of Endodontics, University of North Carolina at Chapel Hill, NC, USA; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
authors.forename: Denniz A
authors.initials: DA
authors.lastname: Zolnoun
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: A Lee
authors.initials: AL
authors.lastname: Dellon
keywords: clitoral pain; complication; nerve entrapment; postoperative pain