Nerve injury: an exceptional cause of pain after TVT

Persistent pain after a tension-free vaginal tape procedure is rare. Perforation or erosion of the tape into the bladder, urethra, or vagina; hematoma formation; and tape rejection are the most common causes. Less frequent causes are injury to the pelvic bone or to iliopectineal ligaments. In this case report, we present the passage of the tape through a nerve structure as the source of persistent and severe retropubic pain. Diagnostic procedures, such as cystoscopy, ultrasound, and MRI scanning, showed no abnormal findings. Treatment was initially conservative, but only locally injected analgesics and corticosteroids relieved the pain temporarily. Finally, surgical exploration revealed the inadvertent course of the tape through branches of the ilioinguinal/iliohypogastric nerve, which only became clear after pathological examination of the excised tape.