Nerve injury locations during retropubic sling procedures

The risk of persistent pain following a retropubic sling is rare (1%). Nerve injuries have been suspected as a cause of persistent postoperative pain. We present two cases of postoperative pain thought to be secondary to injury or mechanical distortion of two different pelvic nerves. Visual exam, cystoscopy, and MRI studies demonstrated no abnormal findings. Manual examination produced site-specific tenderness thought to be associated with a specific nerve distribution. Each patient's pain was first relieved with a local anesthetic block at the site of the pain. One patient required surgical excision of the mesh, and the second patient only required conservative management. Both patients' pain completely resolved. Based on these and other reported cases, along with cadaveric dissections, we hypothesize that retropubic slings can potentially injure the pudendal, ilioinguinal, and iliohypogastric nerve branches.