Management of persistent groin pain after transobturator slings

Abstract

Prolonged groin pain after transobturator tape is uncommon. Three women reported groin pain that had not improved by 3 months postoperatively. Combined steroid and local anesthetic was effective for pain relief in all patients. The differential diagnosis of persistent groin pain after transobturator tape includes adductor muscle strain, osteitis pubis, obturator/groin abscess, structural adhesions, and inflammation, edema or nerve entrapment of the anterior branch of the obturator nerve. No side effects of treatment were noted. Patients that do not respond to local injection may require mesh dissection and excision.

Decreasing transobturator sling groin pain without decreasing efficacy using TVT-Abbrevo

“…Regardless of the precise mechanism, obturator neuropathy after TVT-Obturator sling placement is a difficult problem to manage, for which there is no consensus [12]. Conservative oral and injection analgesic measures have been advocated [13,14]. Where these fail, vaginal excision or lysis of mesh material may improve pain in two-thirds of patients [11].…”

“…1 months (range[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. At 6 months, or beyond, 86 out of 125 (69 %) of the TVT-Obturator patients and 59 out of 100 (59 %) TVTAbbrevo patients returned for follow-up (P value=0.161).…”

Long Term Follow up of the Solyx Single Incision Sling in the Treatment of Female Stress Urinary Incontinence (SUI)

“…Retropubic and transobturator slings have favourable results but require three incisions and blind passage of trocars. This blind needle passage had the potential risk of visceral and vascular damage [7][8][9][10][11][12]. The use of single incision slings is appealing because of its minimal invasiveness, even less than TVT or TOT slings, and potential for decreasing morbidity.…”

Trans‐Vaginal Mesh Revision: A Comprehensive Review on Etiologies and Management Strategies with Emphasis on Postoperative Pain Outcomes

“…Physical exam findings of prominent and tense focal area of mesh underlying the vaginal epithelium with reproducible symptoms on palpation makes one suspicious of mesh contraction. 17 When performed correctly, the obturator or pudendal neurovascular bundles should not be in contact with the mesh, but there exists variability in pelvic anatomic structures such that blind trocar passage can result in chronic neuralgias as a result of either direct damage to the nerves or entrapment. Additionally, cadaveric studies evaluating trocar trajectories demonstrate wide variability in their course, which can also be influenced by patient position during sling insertion.…”

“…Marcus-Braun reported on a cohort of 83 women who underwent 104 procedures for removal of transvaginal mesh for mesh-related complications. The indications for mesh removal were multiple and included erosion (44), infection (30), incomplete voiding (17), and pain (9). Included in this report is the distribution of indications for mesh removal stratified by time from the primary operation.…”