Risks, symptoms, and management of pelvic nerve damage secondary to surgery for pelvic organ prolapse: a report of 95 cases

Abstract

Because secondary nerve damage can appear months or years after the primary procedure, long-term follow-up is mandatory and should focus on nerve damage as well as anatomical and functional outcomes. Laparoscopy is a unique method for etiologic diagnosis and neurosurgical treatment of such nerve lesions through decompression or implantation of an electrode for neuromodulation.

Axotomy of tributaries of the pelvic and pudendal nerves induces changes in the neurochemistry of mouse dorsal root ganglion neurons and the spinal cord

“…In particular, when analyzing chronic postsurgical pain, most of the emphasis seems to be put on the neuropathic pain detected in the incisional area and its association with the injury of parietal non-visceral nerves (Brandsborg et al 2011; Bruce and Krukowski 2006; Burke and Shorten 2009; Dualé et al 2014; Kehlet et al 2006; Possover and Lemos 2011; Reddi and Curran 2014). In fact, most analgesic strategies designed to prevent chronic postsurgical pain used today are employed assuming that nerve damage at the surgical incision and associated pain are the most important components (Bouman et al 2014; Collins et al 2014; Ducic et al 2006; Gyang et al 2014; Kehlet et al 2006; Possover and Lemos 2011; Reddi and Curran 2014). However, injury of visceral nerves may also be of importance to chronic postsurgical pain (Cervero and Laird 1999).…”

Laparoscopic Approach to Intrapelvic Nerve Entrapments

“…7). Among the surgeries with higher risks of inducing such kinds of entrapments are the pelvic reconstructive procedures [12].…”

Neuropelveological assessment of neuropathic pelvic pain

“…This is necessary to adapt the treatment strategy accordingly. Perineal procedures may induce pathologies of the pudendal nerve and abdominal/laparoscopic procedures may affect the sacral nerve roots, while vaginal surgeries can induce both [5]. In a series of 92 consecutive patients with pelvic nerve damage secondary to surgery for pelvic organ prolapse (confirmed by laparoscopic exploration), the most frequent types of nerve damage were injuries to the right S2 nerve root incurred during laparoscopic rectopexy and laparoscopic colpopromontofixation, and injuries to the left S2 nerve root after vaginal uterosacral ligament suspension (McCall procedure).…”

“…After iatrogenic nerve damage, which are frequent in obstetrics and gynecology pudendal neuralgia is common, with etiologies such as compression of the nerve through a postpartum hematoma, fibrosis of the ischiorectal fossa, stretching of the nerve during delivery, or surgical damage during transvaginal sacrospinous colpopexy [3]. Recent interventions using mesh material for sacrospinal fixation [4], sacrocolpopexy, or rectopexy may also expose patients to a risk of pudendal nerve damage [5].…”