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Nerve injury locations during retropubic sling procedures
Hilaire W Fisher1, Peter M Lotze
1Women’s Pelvic Health & Continence Center, 7900 Fannin, Suite 4602, Houston, TX 77054, USA.
International Urogynecology Journal
|November 10, 2010
Summary
Persistent postoperative pain after retropubic sling surgery is rare. This study suggests pelvic nerve injury, including the pudendal, ilioinguinal, and iliohypogastric nerves, may cause this rare complication.
Area of Science:
- Urology
- Neurology
- Surgical Innovation
Background:
- Persistent pain following retropubic sling procedures for stress urinary incontinence is uncommon.
- Nerve injury is a suspected, though rarely confirmed, cause of such pain.
Observation:
- Two cases of persistent postoperative pain were investigated.
- Standard diagnostic methods (visual exam, cystoscopy, MRI) revealed no abnormalities.
- Manual examination identified site-specific tenderness correlating with nerve distributions.
Findings:
- Pain in both patients was initially relieved by local anesthetic nerve blocks.
- One patient underwent successful mesh excision, while the other responded to conservative management.
- Both patients achieved complete pain resolution.
Implications:
- Retropubic slings may pose a risk of injury to the pudendal, ilioinguinal, and iliohypogastric nerves.
- This highlights the importance of considering nerve injury in the differential diagnosis of persistent pelvic pain post-sling placement.
- Further investigation into surgical technique and anatomical considerations may mitigate this risk.
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