Neural pain after uterosacral ligament vaginal suspension

Abstract

Neural compromise has been reported after a wide variety of reconstructive pelvic procedures. We report on two women who had undergone a seemingly uncomplicated transvaginal uterosacral suspension for the treatment of pelvic organ prolapse. Both women presented shortly after surgery with a unilateral, shooting groin pain with radiation along the ipsilateral lumbosacral nerve distribution. Surgical removal of the permanent stitch and physical therapy provided prompt and near-complete relief. This case report describes the possibility of neural compromise after uterosacral ligament suspension.

Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus

“…Only a few case reports are available on acute pelvic nerve damage resulting from pelvic surgeries (3,13). This is in absolute contradiction to the reality if one considers that neurogenic dysfunctions of the lower urinary or intestinal tract (14,15) and chronic neural pelvic pain (3,16,17) resulting from pelvic surgery are common complaints in many medical offices. Probably the main reasons for omission of pelvic nerve pathologies are not only difficulty of diagnosis and treatment but also lack of awareness that such lesions may exist (2).…”

Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse

“…Transvaginal uterosacral plication has been reported to be associated with a high risk of ureteric injury and neurologic morbidity. 10,11 Sacrospinous hysteropexy has been compared favourably with vaginal hysterectomy and concomitant sacrospinous fixation of the vault in a retrospective series of 70 women with an objective success rate of 74%. 12 Posterior intravaginal slingplasty was first described in 2001, but a high rate of mesh complications, including infection and erosion, has since been reported.…”

Gynecologic management of neuropathic pain

“…Similar relief has been described with release of an entrapped branch of the pudendal nerve a year after cystocele surgery and in two patients who potentially had lumbosacral nerve roots compromised at time of uterosacral vault suspension that responded to prompt suture removal within two weeks of the original surgery. 32, 67 How long to wait before attempting surgical release of an acutely entrapped nerve is largely unknown. Many cases clearly do resolve with observation and pain control, and clearly a dialogue with the patient will guide how quickly this decision is made.…”